%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e14359 %T Survival Rate of Gastric Cancer Patients in Jordan: Secondary Data Analysis %A Aqel,Ashraf %A Khader,Yousef %A Arqoub,Kamal %A Nimri,Omar %+ Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, Jordan, 1 962796802040, yskhader@just.edu.jo %K gastric cancer %K survival rate %K Jordanian cancer cases %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gastric cancer accounts for 2.7% of all newly diagnosed cancer cases in Jordan. Objective: The aim of this study was to calculate the survival rate and its determinants among Jordanian patients who were diagnosed with gastric cancer between 2010 and 2014. Methods: A descriptive study was conducted based on secondary analysis of data from the Jordan Cancer Registry during the period of 2010-2014. Only cancer-related deaths were recorded as “death” in the survival analysis. Results: A total of 1388 new cases of gastric cancer were recorded between 2010 and 2014. Of these, 872 (62.8%) were Jordanians and 60.5% were males. The mean age at diagnosis was 58.9 years and the median follow-up time was 1.6 years. The 5-year survival rate decreased significantly from 89% in patients with well-differentiated cancer to 32% in patients with poorly differentiated cancer (P=.005). The overall 5-year survival rate was 37.7% and the median survival was 1.48 years (95% CI 1.179-1.783). The 5-year survival rate decreased significantly with increasing age and with advanced stage of the disease: the 5-year survival rate was 75% for localized-stage, 48% for regional-stage, and 22.7% for distant-metastasis disease (P=.005). Conclusions: This study showed that the overall 5-year survival rate among patients with gastric cancer in Jordan between 2010 and 2014 was 37.7%, which is higher than the reported rates from different countries in the Eastern Mediterranean region such as Egypt. %M 32364509 %R 10.2196/14359 %U https://publichealth.jmir.org/2020/2/e14359 %U https://doi.org/10.2196/14359 %U http://www.ncbi.nlm.nih.gov/pubmed/32364509 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e15812 %T Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana’a, Yemen: Cross-Sectional Study %A Al-Abhar,Nabil %A Moghram,Ghuzlan Saeed %A Al-Gunaid,Eshrak Abdulmalek %A Al Serouri,Abdulwahed %A Khader,Yousef %+ Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Pr. Hamzah St, Amman, 11118, Jordan, 962 796802040, yskhader@just.edu.jo %K injury %K hepatitis B %K vaccination %K biosafety %K laboratory staff %K Yemen %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. Objective: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana’a, Yemen. Methods: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana’a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. Results: A total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). Conclusions: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana’a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen. %M 32229462 %R 10.2196/15812 %U http://publichealth.jmir.org/2020/1/e15812/ %U https://doi.org/10.2196/15812 %U http://www.ncbi.nlm.nih.gov/pubmed/32229462 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e14439 %T Trend of Cutaneous Leishmaniasis in Jordan From 2010 to 2016: Retrospective Study %A Alhawarat,Mohammad %A Khader,Yousef %A Shadfan,Bassam %A Kaplan,Nasser %A Iblan,Ibrahim %+ Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Pr. Hamzah St, Amman, 11118, Jordan, 962 772300390, fazza200079@yahoo.com %K cutaneous leishmaniasis %K incidence %K Jordan %D 2020 %7 24.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cutaneous leishmaniasis (CL) is endemic in the Middle East, with countries such as Syria reporting high incidence rates. Objective: This study aimed to assess the trends in the incidence of cutaneous leishmaniasis (CL) in Jordan from 2010 to 2016. Methods: This retrospective study included all cases of CL that had been reported to the Leishmaniasis Surveillance System in the Department of Communicable Diseases at the Jordan Ministry of Health during the period from 2010 to 2016. A total of 1243 cases were reported and met the case definition. Results: A total of 1243 cases (60.65% [754/1243] males and 39.34% [489/1243] females) were diagnosed during the study period. Of this sample, 233 patients (19.13%) were aged <5 years old, 451 (37.03%) were aged between 5-14 years old, 190 (15.60%) were aged between 15-24 years old, and 344 (28.24%) were aged ≥25 years old. Of those, 646 (51.97%) were Jordanians and 559 (44.97%) were Syrians. The average annual incidence rate of 1.70 per 100,000 people between 2010 and 2013 increased to 3.00 per 100,000 people in the years 2014 to 2016. There was no difference in incidence rates between Jordanians and Syrian refugees between 2010 and 2012. After 2012, the incidence rate increased significantly among Syrian refugees from 1.20 per 100,000 people in 2012 to 11.80 per 100,000 people in 2016. On the contrary, the incidence rate did not change significantly among Jordanians. Conclusions: The incidence rate of leishmaniasis in Jordan has increased in the last three years because of the influx of Syrian refugees into Jordan. A massive effort toward reservoir and vector control, along with actively pursuing diagnosis in endemic foci, will be helpful. Proper and studious reporting of cases is also a necessity for the eradication of this disease. %M 32207696 %R 10.2196/14439 %U http://publichealth.jmir.org/2020/1/e14439/ %U https://doi.org/10.2196/14439 %U http://www.ncbi.nlm.nih.gov/pubmed/32207696 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14413 %T The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis %A Almoayed,Khaled Abdullah %A Bin Break,Ali %A Al-Qassimi,Mutahar %A Assabri,Ali %A Khader,Yousef %+ Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Alhasabah Area, Althawrah District, Sana'a, Yemen, 967 771707060, Khaled.moayed@yahoo.com %K evaluation %K acute %K flaccid %K paralysis %K surveillance %K Yemen %D 2019 %7 6.12.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Acute flaccid paralysis (AFP) surveillance is an essential strategy for poliovirus eradication. Objective: This study aimed to evaluate the performance of the AFP surveillance system in Yemen from 2010 to 2015, identify components that require strengthening, and compare the indicators by year and governorates. Methods: This descriptive study was based on secondary analysis of AFP surveillance data reported during 2010-2015 from all Yemeni governorates. The World Health Organization (WHO) minimum performance standards were used to evaluate the performance of the AFP surveillance system. Results: A total of 3019 AFP cases were reported between January 2010 and December 2015. At the national level, AFP surveillance achieved WHO targets throughout the evaluating period for the nonpolio AFP rate of cases per 100,000 members of the population younger than 15 years of age, proportion of AFP cases reported within 7 days, proportion of AFP cases investigated within 48 hours of notification, proportion of AFP cases with two adequate stool specimens, and proportion of stool specimens from which nonpolio enterovirus was isolated. However, the proportion of specimens that arrived at the central level within 3 days of the first sample collection and the proportion of stool specimens with results sent from the reference laboratory within 28 days of receipt did not reach targets in 2011 and 2015, respectively. Conclusions: The AFP surveillance system in Yemen has met most of the WHO indicator levels. Nevertheless, the evaluation showed areas of weakness regarding the arrival of specimens at the central level within 3 days of the first sample collection and delays in processing of the results and submitting feedback by the laboratory. Therefore, there is a need to strengthen the follow-up of specimens submitted to the laboratory. %M 31808749 %R 10.2196/14413 %U http://publichealth.jmir.org/2019/4/e14413/ %U https://doi.org/10.2196/14413 %U http://www.ncbi.nlm.nih.gov/pubmed/31808749 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14295 %T An Electronic Disease Early Warning System in Sana’a Governorate, Yemen: Evaluation Study %A Mayad,Mona %A Alyusfi,Reema %A Assabri,Ali %A Khader,Yousef %+ Yemen Field Epidemiology Training Program, Administrator of Epidemiology Administration in National Center of Public Health Laboratories, National Center of Public Health Laboratories, Sana'a, Yemen, 967 773603905, alferdos25@yahoo.com %K evaluation %K eDEWS %K field epidemiology %K Yemen %D 2019 %7 19.11.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Electronic Disease Early Warning System (eDEWS) is one of the effective programs in epidemiological surveillance. Objective: This study aimed to identify the strengths and weaknesses of eDEWS in Sana’a governorate, determine its usefulness, and assess its performance in terms of the system attributes, including simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability. Methods: Updated guidelines on the evaluation of public health surveillance from the Center for Disease Control and Prevention (CDC) were used to evaluate the eDEWS in Sana’a governorate. Stakeholders from different levels were interviewed about the performance of the eDEWS. Results: The overall score for the usefulness of the eDEWS was good (mean=83%). The overall system performance was good (86%). The highest attribute score was 100% for representativeness and the lowest score was 70% for stability. The system simplicity and acceptability were good. Although the system representativeness and flexibility were excellent, the stability was average. System completeness and timeliness were 100%. Conclusions: In conclusion, eDEWS in Yemen is useful and met its main objective. The overall level of system performance was good. %M 31742559 %R 10.2196/14295 %U http://publichealth.jmir.org/2019/4/e14295/ %U https://doi.org/10.2196/14295 %U http://www.ncbi.nlm.nih.gov/pubmed/31742559 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14664 %T A Collaborative Initiative to Strengthen Sustainable Public Health Capacity for Polio Eradication and Routine Immunization Activities in the Eastern Mediterranean Region %A Al Gunaid,Magid %A Lami,Faris %A Jarour,Najwa %+ Polio and Immunization Team, Global Health Development/Eastern Mediterranean Public Health Network, Shemeisani, Abdallah Ben Abbas Street, Building No 42, Amman, , Jordan, 962 65519962 ext 409, mgunaid@globalhealthdev.org %K GHD/EMPHNET %K Global Polio Eradication Initiative %K acute flaccid paralysis %K vaccine-preventable disease %K VPD %K surveillance %K Eastern Mediterranean region %K EMR %K Global Vaccine Action Plan %K demand creation %K microplans %K polio transition %D 2019 %7 29.10.2019 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project “Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities” with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention’s Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries’ needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions. %M 31663863 %R 10.2196/14664 %U http://publichealth.jmir.org/2019/4/e14664/ %U https://doi.org/10.2196/14664 %U http://www.ncbi.nlm.nih.gov/pubmed/31663863 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14461 %T The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study %A Torbosh,Amr %A Al Amad,Mohammed Abdulla %A Al Serouri,Abdulwahed %A Khader,Yousef %+ Yemen Field Epidemiology Training Program, The Eastern Mediterranean Public Health Network, Ministry of Health, 2nd Floor, Sanaa, Yemen, 967 777238465, amrtorbosh@gmail.com %K immunization coverage %K 2015 war %K impact %K Y-FETP %K Yemen %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: After 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation. Objective: The aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year. Methods: Data on vaccination coverage for 2012-2015 were obtained from the national Expanded Program on Immunization (EPI). The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year. Results: Although there was an increase from 2012 to 2014 in the national coverage for penta-3 vaccine (82% in 2012 vs 88% in 2014) and measles vaccine (70% in 2012 vs 75% in 2014), the coverage was still below the national target (≥95%). Furthermore, the year 2015 witnessed a marked drop in the national coverage compared with 2014 for the measles vaccine (66% in 2015 vs 75% in 2014), but a slight drop in penta-3 vaccine coverage (84% in 2015 vs 88% in 2014). Bacillus Calmette–Guérin vaccine also showed a marked drop from 73% in 2014 to 49% in 2015. These reductions were more marked in governorates that witnessed armed confrontations (eg, Taiz, Lahj, and Sa’dah governorates). On the other hand, governorates that did not witness armed confrontations showed an increase in coverage (eg, Raymah and Ibb), owing to an increase in their population because of displacement from less secure and confrontation-prone governorates. Conclusions: This analysis demonstrated the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery or provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite. %M 31647465 %R 10.2196/14461 %U http://publichealth.jmir.org/2019/4/e14461/ %U https://doi.org/10.2196/14461 %U http://www.ncbi.nlm.nih.gov/pubmed/31647465 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14349 %T Rapid Response Teams’ Initiative: Critical Role and Impact on National and Eastern Mediterranean Regional Emergency Management Capacity Building %A Araj,Rawan %A Odatallah,Ali %A Mofleh,Jawad %A Samy,Sahar %A Ben Alaya,Nissaf %A Alqasrawi,Sultan %+ Global Health Development and the Eastern Mediterranean Public Health Network, Wasfi al Tal, Amman, 20853, Jordan, 962 778284521, raraj@globalhealthdev.org %K response teams %K emergency %K management %K capacity building %K training %D 2019 %7 16.10.2019 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Rapid response teams (RRTs) are essential to contain the harmful effects of emergency situations and to coordinate actions in the fragile environment of the Eastern Mediterranean region (EMR). The Global Health Development and the Eastern Mediterranean Public Health Network (EMPHNET) implemented RRTs to fill the human resources gap and to enable the member states to build their capacity in rapid assessment and response to public health events to reduce human suffering. To build the capacity of the member states in the field of rapid response and to build a strong team of rapid response specialists at the regional level, EMPHNET implemented this initiative at two levels. The first was a basic regional RRT course (July 2012). It was an introductory course for the selected candidates to provide insight and to enhance the knowledge and skills needed to be part of an RRT. The training included 32 participants from nine EMR countries. The course was designed to allow the facilitators and selection committee to select 15 to 20 potential candidates for the advanced RRT course. The second was the advanced RRT course (September 2010 to October 2012) for training the trainers and preparing the RRTs for deployment. A series of RRT training workshops were held, with more than 650 health staff from 12 countries trained. In all workshops that were conducted during 2016-2017, the trainees showed significant improvement in their knowledge and skills. %M 31621636 %R 10.2196/14349 %U https://publichealth.jmir.org/2019/4/e14349 %U https://doi.org/10.2196/14349 %U http://www.ncbi.nlm.nih.gov/pubmed/31621636 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14348 %T Preventing Emerging and Re-emerging Infections in the Eastern Mediterranean Region: Gaps, Challenges, and Priorities %A Araj,Rawan %A Alqasrawi,Sultan %A Samy,Sahar %A Alwahdanee,Ghaya %A Wadi,Jamal %A Mofleh,Jawad %A Alsanouri,Tarek %+ Global Health Development/Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No 42, Amman, 91116, Jordan, 962 778284521, raraj@globalhealthdev.org %K emerging %K infectious %K diseases %K Eastern Mediterranean %D 2019 %7 9.10.2019 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: The Eastern Mediterranean Public Health Network, supported by the Biosecurity Engagement Program, contributed significantly to strengthening the preparedness and response to the emerging and re-emerging infections in the region. Objective: This study aimed to determine the gaps, challenges, and priorities for preventing the emerging and re-emerging infections, with a focus on biosafety and biosecurity in four countries of the region, namely, Egypt, Iraq, Jordan, and Morocco. Methods: A total of two different methods were used to determine the gaps and priorities for preventing the emerging and re-emerging infections. The first method was a rapid assessment for the preparedness and response to the emerging and re-emerging infections in four countries of the region, with a focus on biosafety and biosecurity. The second method was a face-to-face round table meeting of the participating teams for two days, where the teams from all countries presented their countries’ profiles, findings, priorities, and gaps based on the countries’ assessments. Results: The assessment and meeting resulted in several priorities and recommendations for each of the countries in the areas of legislation and coordination, biosafety and biosecurity, surveillance and human resources, case management and response, infection control and prevention, and risk communication and laboratory capacity. Conclusions: Many recommendations were relatively consistent throughout, including improving communication or building collaborations to improve the overall health of the country. %M 31599734 %R 10.2196/14348 %U https://publichealth.jmir.org/2019/4/e14348 %U https://doi.org/10.2196/14348 %U http://www.ncbi.nlm.nih.gov/pubmed/31599734 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14252 %T Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study %A Bennani,Kenza %A Khattabi,Asmae %A Akrim,Mohammed %A Mahtar,Mohamed %A Benmansour,Najib %A Essakalli Hossyni,Leila %A Karkouri,Mehdi %A Cherradi,Nadia %A El Messaoudi,My Driss %A Lahlou,Ouafae %A Cherkaoui,Imad %A Khader,Yousef %A Maaroufi,Abderrahmane %A Ottmani,Salah-Eddine %+ Direction of Epidemiology and Diseases Control, Ministry of Health, 71 Avenue Ibn Sina Agdal-Rabat Morocco, Rabat, 10080, Morocco, 212 661390920, kenzabennani20@gmail.com %K lymph node tuberculosis %K yield %K histopathology %K positive predictive value %K Morocco %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The frequency of occurrence of extrapulmonary tuberculosis (EPTB) has been increasing globally over the last two decades. In Morocco, EPTB cases account for 46% of the patients reported with a new episode of tuberculosis (TB). Lymph node TB (LNTB) is the most common form of EPTB. In line with the guidelines of the National TB Program, the diagnosis is mainly based on clinical evidence, including histopathology. Objective: This study aimed to evaluate the yield of histopathology testing in the diagnosis of LNTB. Methods: This cross-sectional, prospective study was conducted among patients with cervical lymph node who were enrolled in the study from November 2016 to May 2017 in three regions of Morocco. We compared the outcomes of histopathological testing with those of bacteriology. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of histopathology testing were calculated. Culture and Xpert tests were used as the gold standard Laboratoty Testing. Results: A total of 262 patients were enrolled in this study. The Se, Sp, PPV, and NPV of histopathology testing were 95.6% (129/135), 64.6% (82/127), 74.1% (129/174), and 93.2% (82/88), respectively, in the presence of granuloma with or without caseous necrosis and were 84.4% (114/135), 74.8% (95/127), 78.1% (114/146), and 81.9% (95/116), respectively, in the presence of granuloma with caseous necrosis. The granuloma with caseous necrosis was associated with increased PPV and Sp of histopathology testing (P<.05). Conclusions: The presence of the granuloma with caseous necrosis in the histopathological examination had significantly improved the yield of histopathology testing for the diagnosis of LNTB. The findings recommend to maintain histopathology testing in establishing the LNTB diagnosis and to explore other techniques to improve it. %M 31599732 %R 10.2196/14252 %U https://publichealth.jmir.org/2019/4/e14252 %U https://doi.org/10.2196/14252 %U http://www.ncbi.nlm.nih.gov/pubmed/31599732 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14451 %T Impact of Training of Primary Health Care Centers’ Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study %A Amily,Ali Sadiq %A Lami,Faris %A Khader,Yousef %+ Immunization Section, Wasit Directorate of Health, Iraqi Ministry of Health, Tamooz, Kut, Iraq, 964 7813928919, amily_ali@yahoo.com %K immunization %K primary health care %K intervention %K practices %K Iraq %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children’s Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objective: The goal of this study was to assess the impact of training of primary health care centers’ (PHCs) vaccinators on the quality of ISPs. Methods: This was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, “Managing an Immunization Session”, and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores. Results: A total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02). Conclusions: The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services. %M 31593540 %R 10.2196/14451 %U https://publichealth.jmir.org/2019/4/e14451 %U https://doi.org/10.2196/14451 %U http://www.ncbi.nlm.nih.gov/pubmed/31593540 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14510 %T Real-Time Surveillance of Infectious Diseases and Other Health Conditions During Iraq’s Arbaeenia Mass Gathering: Cross-Sectional Study %A Lami,Faris %A Hameed,Inam %A Jewad,Abdul Wahhab %A Khader,Yousef %A Amiri,Mirwais %+ Department of Community and Family Medicine, College of Medicine, University of Baghdad, Bab Al Muadham, Resafa, Baghdad, 00964, Iraq, 964 7901402692, farislami@gmail.com %K mass gathering %K Arbaeenia %K surveillance %K Iraq %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The most common religious mass gatherings in the Middle East are the Hajj at Mecca in Saudi Arabia, which occurs annually, and the Arbaeenia in Karbala. The importance of developing public health surveillance systems for mass gatherings has been previously emphasized in other reports. Objective: This study aimed to describe the common illnesses and health conditions affecting people during the Arbaeenia mass gathering in Iraq in 2016. Methods: A total of 60 data collectors took part in the field data collection over a period of 11 days, from November 12, 2016 to November 22, 2016. Data were collected from 20 health outlets along the major route from Najaf to Karbala (10 health facilities in each governorate). Two digital forms, the Health Facility Survey and the Case Survey, were used for data collection. Results: A total of 41,689 patients (33.3% female and 66.7% male) visited the 20 health care facilities over a period of 11 days from November 12, 2016 to November 22, 2016. More than three quarters of patients (77.5%; n=32,309) were between 20-59 years of age, more than half of patients were mainly from Iraq (56.5%; n=23,554), and about 38.9% (n=16,217) were from Iran. Patients in this study visited these health care facilities and presented with one or more conditions. Of a total 41,689 patients, 58.5% (n=24,398) had acute or infectious conditions and symptoms, 33.1% (n=13,799) had chronic conditions, 23.9% (n=9974) had traumas or injuries, 28.2% (n=11,762) had joint pain related to walking long distances, and 0.3% (n=133) had chronic dermatologic conditions. Conclusions: The Arbaeenia mass gathering in 2016 exerted a high burden on the Iraqi health care system. Therefore, efforts must be made both before and during the event to ensure preparedness, proper management, and control of different conditions. %M 31588905 %R 10.2196/14510 %U https://publichealth.jmir.org/2019/4/e14510 %U https://doi.org/10.2196/14510 %U http://www.ncbi.nlm.nih.gov/pubmed/31588905 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14294 %T Performance of Multidrug-Resistant Tuberculosis Surveillance in Yemen: Interview Study %A Abdulmughni,Jihan %A Mahyoub,Esam Mohammed %A Alaghbari,Abdulaziz Thabit %A Al Serouri,Abdulwahed Abdelgabar %A Khader,Yousef %+ Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Sana'a, Yemen, 967 771299020, gihanthr@gmail.com %K multidrug-resistant tuberculosis %K surveillance evaluation %K Yemen %K field epidemiology program %D 2019 %7 3.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multidrug-resistant tuberculosis (MDR-TB) is a major challenge to ending TB occurrence by 2035. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The National Tuberculosis Control Program (NTCP) established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The NTCP established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. Objective: This study aimed to assess the performance of MDR-TB surveillance and determine its strengths and weaknesses. Methods: We used the updated Center for Diseases Control and Prevention guidelines for evaluating public health surveillance systems. Interviews were conducted with NTCP managers and Regional MDR-TB centers’ staff using a semistructured questionnaire. We used a 5-point Likert scale to assess the usefulness and other attributes (eg, simplicity and flexibility). The mean percentage was calculated for each attribute and used for the final rank of the performance: poor (<60%), average (60%-80%), and good (>80%). Results: The MDR-TB surveillance system achieved good performance in usefulness (87%), acceptability (82%), and data quality (91%); average performance in flexibility (61%) and simplicity (72%); and poor performance in stability (55%). The overall performance score was average (74%). Although strong commitment, good monitoring, and well-trained staff are the main strengths, depending on an external fund is a major weakness along with unavailability of the MDR-TB unit at the governorate level. Conclusions: Although the MDR-TB surveillance system has achieved an average overall performance, more efforts are required to improve its stability by ensuring constant power supply to enable laboratories to perform necessary diagnostic and follow-up tests. Gradual replacement of donors’ funds by the government is recommended. Scaling up of MDR-TB services and removing access barriers are crucial. %M 31584002 %R 10.2196/14294 %U https://publichealth.jmir.org/2019/4/e14294 %U https://doi.org/10.2196/14294 %U http://www.ncbi.nlm.nih.gov/pubmed/31584002 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14238 %T Perceived Stress Among Resident Doctors in Jordanian Teaching Hospitals: Cross-Sectional Study %A Maswadi,Nizar %A Khader,Yousef S %A Abu Slaih,Ahmad %+ Department of Parasitic and Zoonotic Diseases, Directorate of Communicable Diseases, Ministry of Health, Wadi as Sir, Byader, Al-Jnadweil, Moh'd Aqeelih Street, Building Number 7, Amman, 11814, Jordan, 962 795972629, nizar-83@outlook.com %K psychology %K physicians %K teaching hospitals %K Jordan %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Medical residents in Jordanian hospitals are involved in many clinical and nonclinical tasks that expose them to various stress factors. High stress and burnout have the potential to negatively impact work performance and patient care, including medication errors, suboptimal care, clinical errors, and patient dissatisfaction. Objective: This study aimed to determine the perceived stress among medical residents in Jordanian hospitals and its associated risk factors. Methods: A cross-sectional study was conducted among residents in Jordanian hospitals. A cluster sample of 5 hospitals with residency programs was selected from different health sectors. All residents who were working in the selected hospitals were invited to participate in this study, during the period from April to July 2017. A total of 555 residents agreed to participate in this study, giving a response rate of 84%. The perceived stress scale (PSS) was used for assessment. Results: A total of 398 male and 157 female residents were included in this study. The mean PSS score in this study was 21.6; 73% (405/555) of the residents had moderate level of stress, and 18% (100/555) had high level of stress. About 6.7% (37/555) of the residents had hypertension, 2.7% (15/555) had diabetes, 3.2% (18/555) had heart disease, and 8.5% (47/555) were anemic. 233 (42%) respondents complained of back pain, and 161 (29%) of the respondents complained of insomnia. Stress was associated with higher workload, sleep deprivation, and dissatisfaction in the relationship with colleagues, with income, and with the program. In multivariate analysis, the following factors were significantly associated with stress: female gender, dissatisfaction with working environment, and facing work-related, academic, and family stressors. Conclusions: The majority of medical residents in Jordanian hospitals felt nervous and stressed. Conducting stress management programs during residency and improving the work environment are strongly recommended. %M 31579024 %R 10.2196/14238 %U https://publichealth.jmir.org/2019/4/e14238 %U https://doi.org/10.2196/14238 %U http://www.ncbi.nlm.nih.gov/pubmed/31579024 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e14217 %T Evaluation of the Acute Flaccid Paralysis Surveillance System in Polio-Free Jordan, 2012-2016: Retrospective Secondary Analysis %A Zerriouh,Fatima %A Khader,Yousef %A Qasem,Nabil %A Abusal,Kamel %A Iblan,Ibrahim %A Ghaffari,Layla %A Abdallat,Mohammed %+ Jordan Field Epidemiology Training Program/Community Medicine Residency Program, Jordan Ministry of Health, 6, Mothaffar Qotoz Street, Basman, Amman,, Jordan, 962 795410566, toom832016@gmail.com %K polio eradication %K acute flaccid paralysis %K surveillance %K evaluation %K Jordan %K JFETP %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As part of the polio-eradication strategy, the World Health Organization (WHO) has established a global acute flaccid paralysis (AFP) surveillance system. AFP surveillance has successfully helped Jordan achieve polio-free certification. However, there is a substantial risk of polio importation from neighboring countries including Syria and Iraq. Objective: This study aimed to evaluate the AFP surveillance in Jordan and identify areas that need improvement. Methods: This retrospective study is a secondary analysis of data that were routinely collected between 2012 and 2016 by Jordan’s Expanded Program on Immunization. The WHO’s minimum performance indicators were used to evaluate the AFP surveillance. Results: Cumulatively, 328 AFP cases had been reported. Almost half (n=168, 51.3%) of the patients were aged 1-5 years, and 55.8% (n=183) were male. All cases were discarded (classified as a nonpolio case). The most common cause of AFP was Guillain-Barre Syndrome (n=115, 35.1%). The annualized nonpolio AFP rate increased from 1.4/100,000 children below 15 years of age in 2012 to 4.3 in 2016. National and subnational sensitivities were not met in 2012 and 2013. Adequacy of stool specimens and timeliness of specimens arriving at and processed in the laboratory were constantly above the minimum target. Timeliness of the investigation met the expected target but with a decreasing trend. The nonpolio enterovirus isolation rate was below the target, except in 2016. Conclusions: The AFP surveillance system in Jordan is performing well; however, additional efforts are needed to strengthen the subnational sensitivity. The cold chain from sample collection to laboratory testing has to be maintained to ensure the reliability of stool specimens required for isolation of the nonpolio enterovirus. %M 31573938 %R 10.2196/14217 %U http://publichealth.jmir.org/2019/3/e14217/ %U https://doi.org/10.2196/14217 %U http://www.ncbi.nlm.nih.gov/pubmed/31573938 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e14215 %T Risk Factors for End-Stage Renal Failure Among Patients on Hemodialysis in Aljomhory Hospital, Sa’adah Governorate, Yemen: Hospital-Based Case-Control Study %A Dahnan,Mohammed %A Assabri,Ali M %A Khader,Yousef S %+ Yemen Field Epidemiology Training Program, Al Qaherah Street, Sa'adah, 00967, Yemen, 967 0711446611, abofares4000@hotmail.com %K renal failure %K end-stage renal failure %K risk factors %K case-control study %K Yemen %D 2019 %7 25.9.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: More than 16% of the world’s population is affected by chronic kidney disease, and these people are at the highest risk of developing end-stage renal failure (ESRF). Objective: The aim of this study was to determine the risk factors of ESRF in Sa’adah Governorate in Yemen. Methods: A hospital-based case-control study (86 cases and 263 controls) was conducted in the Aljomhory Hemodialysis Center in Sa’adah city, Yemen. Patients with ESRF who attended the hemodialysis center in Aljomhory Hospital in Sa’adah City from January 1 to February 15, 2016, were included. Control participants were healthy persons without end-stage renal disease (ESRD) who attended Aljomhory Hospital as outpatients’ relatives during the study period. Results: A total of 86 cases and 263 controls were included in this study. The mean age was 43.3 (SD 17.7) years for cases and 32.3 (SD 13.0) years for controls. In univariate analysis of factors associated with ESRD, patients aged≥40 years were 3.7 times more likely to have ESRD than younger patients. The odds of ESRD was higher among men than women. Illiteracy was significantly associated with higher odds of ESRD. Hypertension (odds ratio [OR]=8.34), diabetes (OR=3.07), cardiovascular diseases (OR=12.71), presence of urinary stones (OR=21.87), recurrent urinary tract infection (OR=9.64), cigarette smoking (OR=2.44), and shammah use (OR=6.65) were significantly associated with higher odds of ESRD. Hypertension (OR=6.68), urinary stones (OR=16.08), and recurrent urinary tract infection (OR=8.75) remained significantly associated with ERD in multivariate analysis. Conclusions: Hypertension, presence of urinary stones, and recurrent urinary tract infections were significantly associated with ESRF development. Improving the management of hypertension and designing suitable interventions to control problems of the urinary tract would help reduce ESRD prevalence. %M 31573930 %R 10.2196/14215 %U https://publichealth.jmir.org/2019/3/e14215 %U https://doi.org/10.2196/14215 %U http://www.ncbi.nlm.nih.gov/pubmed/31573930 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e14227 %T Outbreak Investigation of a Multipathogen Foodborne Disease in a Training Institute in Rabat, Morocco: Case-Control Study %A Moumni Abdou,Houda %A Dahbi,Ilham %A Akrim,Mohammed %A Meski,Fatima Zahra %A Khader,Yousef %A Lakranbi,Mohammed %A Ezzine,Hind %A Khattabi,Asmae %+ Field Epidemiology Training Program, Ecole Nationale de Santé Publique, Ministry of Health, 335 Ave Mohammed V, Rabat, Morocco, 212 661079082, houdamoumnni@gmail.com %K disease outbreaks %K foodborne diseases %K Staphylococcus %K Escherichia coli %D 2019 %7 25.09.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On June 18, 2017, the public health service was alerted about 43 students in the training institute in Rabat who were admitted to the emergency room for acute gastroenteritis following the uptake of a meal a day before. Objective: This study aimed to investigate the foodborne disease outbreak by confirming the outbreak, identifying the source of contamination, and recommending control measures. Methods: We conducted a case-control study. Cases and controls were selected in a ratio of 1:1. We defined a case as any member of the training institute who attended the Ramadan buffet in the institute’s restaurant and who had presented, in the weekend of June 16 to 20, 2017, symptoms of diarrhea or vomiting with at least one of the following signs: abdominal pain, fever, headache, nausea, and dizziness. A control was defined as anyone who attended the Ramadan buffet in the institute’s restaurant but had not presented any symptoms from June 16 to 20, 2017. We conducted a bivariate and multivariable analysis. Stools of ill students were collected, and a food specimen was collected for bacterial testing. Results: A total of 50 cases and 50 controls were selected. Among the cases, males were predominant (43/50, 86%); the median age was 21 years. A total of 47 cases sought medical care. There were no hospitalizations and no deaths. The episode was short with an estimated average incubation period of 9 hours. The epidemic curve oriented toward a common source of contamination. Among food items, briwates were strongly associated with the illness with an odd ratio of 14.23 (95% CI 5.04-40.04; P<.001). Laboratory testing of briwates showed presence of Escherichia coli O157 and Staphylococcus aureus. Conclusions: This foodborne disease outbreak was likely caused by briwates that was contaminated with S aureus and E coli. We recommended strengthening hygiene measures. Food handling techniques should be taught as part of continuous professional development for food handlers. %M 31573941 %R 10.2196/14227 %U https://publichealth.jmir.org/2019/3/e14227 %U https://doi.org/10.2196/14227 %U http://www.ncbi.nlm.nih.gov/pubmed/31573941 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e14992 %T The Eastern Mediterranean Public Health Network: A Resource for Improving Public Health in the Eastern Mediterranean Region %A Al Nsour,Mohannad %+ The Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No. 42, Shmaisani, Amman, , Jordan, 962 775463000, Executive.director@globalhealthdev.org %K field epidemiology %K public health %K training %K research %D 2019 %7 06.09.2019 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Countries in the Eastern Mediterranean Region (EMR) face many challenges in terms of improving population health and progressing toward sustainable development goals (SDGs). This paper aims to describe the approach taken by the Eastern Mediterranean Public Health Network (EMPHNET) to help strengthen health systems in the EMR and enable progress toward sustainable development targets, the tools it used, and its achievements. The EMPHNET is a nonprofit organization that has worked to support EMR countries in strengthening their public health systems since its establishment in 2009. The EMPHNET invests in building workforce capacity in applied epidemiology by supporting field epidemiology training programs in more than 10 countries in the EMR, while ensuring country ownership of these programs. The EMPHNET established the Global Health Development (GHD) to maximize support for positive change and SDG progress. As an implementing arm to the EMPHNET, GHD aligns its strategies with national policies and directions. The GHD/EMPHNET works at the regional, national, and subnational levels and tailors solutions for the local context. Over the past years, the EMPHNET succeeded in partnering with over 13 countries and provided technical assistance to leverage country efforts and maximize resource use. The EMPHNET’s Center of Excellence for Applied Epidemiology focuses on building capacity in population health and applied epidemiology. The EMPHNET supports countries in delivering effective public health programs by building capacity and conducting research to prevent and control emerging and reemerging diseases, vaccine-preventable diseases, and noncommunicable diseases. The commitment to the region, together with the increased trust and assertion from the countries, helped GHD/EMPHNET build a strong portfolio, which was made possible by the interconnected effort that continues to nurture and foster better health among people living in the EMR. %M 31493322 %R 10.2196/14992 %U http://publichealth.jmir.org/2019/3/e14992/ %U https://doi.org/10.2196/14992 %U http://www.ncbi.nlm.nih.gov/pubmed/31493322