Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit最新文献

{"title":"Five-year analysis of antibiotic consumption at university teaching hospitals in Tunisia.","authors":"Asma Mhiri, Manel Turki, Youssef Zanina, Himanshu A Gupte, Garry Aslanyan, Collins Timire, Abubaker Suliman, Hela Ghali, Samiha Toumi, Aida Jarraya, Aimen Abbassi, Khouloud Ben Jeddou, Balsam Kacem, Taoufik Borji, Houyem Laatiri, Myriam Khrouf, Abderrazek Hedhili","doi":"10.26719/2026.32.4.188","DOIUrl":"10.26719/2026.32.4.188","url":null,"abstract":"<p><strong>Background: </strong>A national antimicrobial consumption reporting system has been established in Tunisia, however, regional, hospital and departmental data on consumption remain limited.</p><p><strong>Aim: </strong>To assess annual antibiotic consumption trends in Tunisia's university teaching hospitals from 2018 to 2022.</p><p><strong>Methods: </strong>We analysed data on antibiotic consumption for 2018 to 2022 by patients aged ≥18 years admitted into 5 university teaching hospitals in Tunisia, based on the WHO defined daily doses per 1000 inhabitants per day and the access, watch and reserve classification. We assessed the differences between year, region, specialty and antibiotic classifications using the Friedman test. P ≤ 0.05 was considered statistically significant.</p><p><strong>Results: </strong>There was no significant difference in antibiotic consumption between the 5 hospitals over the 5-year period (P = 0.455). However, there were consistent significant differences between hospitals in the different regions and between antibiotic categories. There were significant differences in antibiotic consumption between the different hospital departments. The highest consumption was observed in the intensive care units (increasing from 154.2 defined daily doses per 1000 inhabitants per day in 2018 to 174.9 in 2022), which also had the highest increase in the consumption of reserve antibiotics (12.6% in 2018 to 16.7% in 2022).</p><p><strong>Conclusion: </strong>The relatively stable antibiotic consumption observed in our study does not imply appropriate use. There is a need for robust antibiotic use surveillance systems in Tunisian hospitals, especially in intensive care units, alongside targeted interventions to effectively address antimicrobial resistance.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 5","pages":"188-196"},"PeriodicalIF":1.9,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost, availability and affordability of antibiotics in Islamic Republic of Iran.","authors":"Nabizadeh Azita, Bobson Derrick Fofanah, Zahra Jahangard-Rafsanjani, Fatemeh Nosrati, Neda Khoz, Arian Radfar, Robert F Terry, Mohammad M Mojahedian","doi":"10.26719/2026.32.5.297","DOIUrl":"https://doi.org/10.26719/2026.32.5.297","url":null,"abstract":"<p><strong>Background: </strong>Cost, availability and accessibility can influence the patterns of antibiotic use, adherence to prescriptions and the development of antimicrobial resistance.</p><p><strong>Aim: </strong>To assess the cost, availability and affordability of antibiotics in Islamic Republic of Iran using the WHO access, watch and reserve classification.</p><p><strong>Methods: </strong>We analysed secondary data for March 2023 to March 2024 on cost, availability and affordability of antibiotics in Islamic Republic of Iran, using the WHO access, watch and reserve classification. Cost and affordability were compared between the access, watch and reserve antibiotic groups using the Kruskal-Wallis and Mann-Whitney U tests. P ≤ 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Most injectable antibiotics were unaffordable while most oral formulations were affordable. Among the injectables, streptomycin was the cheapest (15 000 IRR/defined daily dose), followed by procaine-benzylpenicillin (82 325 IRR/defined daily dose), while temocillin was the most expensive (25 828 000 IRR/defined daily dose). However, streptomycin and temocillin were not in the essential medicines list. Among the orals, nitrofurantoin was the cheapest (12 370 IRR/defined daily dose) while linezolid was the most expensive (1 030 558 IRR/defined daily dose). There were statistically significant differences in prices (P = 0.007) and affordability (P = 0.035) between the access, watch and reserve groups. Affordability was significantly lower for the reserve group of antibiotics (P = 0.04).</p><p><strong>Conclusion: </strong>Our findings show that although access antibiotics remain largely affordable, watch group antibiotics were used excessively. Targeted policies are needed on the pricing, production, distribution, and prescription of antibiotics in Islamic Republic of Iran to promote rational use and curb antimicrobial resistance.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 5","pages":"297-305"},"PeriodicalIF":1.9,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights and imperatives on antimicrobial resistance in the Eastern Mediterranean Region.","authors":"Hanan H Balkhy","doi":"10.26719/2026.32.5.230","DOIUrl":"10.26719/2026.32.5.230","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) has become entrenched across the Eastern Mediterranean Region (EMR)- undermining our health, our development and our security. Despite progress in developing AMR national action plans (NAP), strengthening infection prevention and control (IPC), and reporting AMR and consumption data to WHO's surveillance system, the AMR burden continues to increase. In 2021 alone, bacterial AMR was directly responsible for nearly 100 000 sepsis-related deaths in the Region -more than 1 in 6 of all sepsis deaths. These stark figures show that AMR is a systemic crisis requiring an urgent, coordinated response.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 5","pages":"230-232"},"PeriodicalIF":1.9,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaling up human papilloma virus vaccination in Pakistan.","authors":"Sara Asif","doi":"doi.org/10.26719/2026.32.4.225","DOIUrl":"https://doi.org/doi.org/10.26719/2026.32.4.225","url":null,"abstract":"","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"225"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidrug resistance and mortality in patients with hospitalacquired urinary tract infections in Islamic Republic of Iran.","authors":"Sara Minaeian, Ajay Mv Kumar, Marjan R Farzami, Vinayagamoorthy Venugopal, Divya Nair, Kianosh Kamali, Mohammed Zeinali, Arash Seifi, Soheil Rahmani Fard, Azita Nabizadeh","doi":"doi.org/10.26719/2026.32.4.197","DOIUrl":"doi.org/10.26719/2026.32.4.197","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired urinary tract infections are a frequent complication in intensive care units. They are increasingly being associated with multidrug-resistance, especially in low-resource settings.</p><p><strong>Aim: </strong>To assess the uropathogenic and antimicrobial resistance patterns and identify patient-related factors associated with multidrug resistance and mortality among patients with hospital-acquired urinary tract infections in Tehran, Islamic Republic of Iran.</p><p><strong>Methods: </strong>We analysed secondary data on all patients aged ≥ 18 years who had hospital-acquired urinary tract infections and were admitted to intensive care units of 45 public and private hospitals in Tehran, Islamic Republic of Iran, between 2022 and 2024. We examined the associations between the demographic and clinical variables using prevalence ratios and the outcomes of interest using relative risks. P ≤ 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Of the 2467 patients, 60% were catheterised. A bacterial pathogen was isolated from 77% and Candida spp. from 23%. The most common pathogens were Escherichia coli (26%), Klebsiella spp. (22%) and Candida spp. (23%). Seventy-two percent of 1590 patients assessed exhibited multidrug resistance. Males, catheterised patients and patients with extended catheter use (> 8 days) had higher prevalence of multidrug resistance. Overall mortality rate was 42% and mortality was highest among patients with prolonged catheter use (57%), those admitted in public hospitals (51%) and those infected with Candida spp (60%).</p><p><strong>Conclusion: </strong>The alarmingly high prevalence of multidrug resistance and high mortality rate among patients with hospital-acquired urinary tract infections indicate the need to enhance infection prevention and control practices in Iranian hospitals, and to significantly improve antibiotic susceptibility testing and antimicrobial resistance surveillance.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"197-205"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on primary health care reform in Pakistan.","authors":"Emma J Hannay, Nukhba Zia, Caitlin Kennedy, A Abdul Ghaffar, David H Peters","doi":"doi.org/10.26719/2026.32.4.212","DOIUrl":"doi.org/10.26719/2026.32.4.212","url":null,"abstract":"<p><strong>Background: </strong>Primary health care reform in low- and middle-income countries involves complex processes of prioritisation and agenda-setting. Evidence remains limited on how the COVID-19 pandemic influenced these processes at the subnational level.</p><p><strong>Aim: </strong>To examine how COVID-19 affected primary health care reform in Khyber Pakhtunkhwa, Pakistan.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 14 key informants, including provincial health leaders, provincial political leaders and their advisers, and representatives of national and international organisations, and reviewed relevant supporting documents. We analysed the data inductively through thematic coding and process tracing across data sources.</p><p><strong>Results: </strong>Most of the respondents agreed that the pandemic facilitated the implementation of reforms at the primary health care level, by strengthening advocacy and political influence. The reforms began around August 2020 and included improved financial management and allocation of resources, establishment of primary health care management committees, increased budget for essential medicines, recruitment of additional frontline clinical staff, and outsourcing of selected support services. Investments in public health increased through an almost 40% increase in the health budget between the 2019/2020 and 2022/2023 financial years.</p><p><strong>Conclusion: </strong>COVID-19 created an opportunity to advance primary health care reform at the provincial level in Khyber Pakhtunkhwa, Pakistan. There is a need to sustain and improve on these reforms to strengthen primary health care services and advance towards the longer-term health goals and Universal Health Coverage.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"212-218"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiologic analysis of rabies cases among humans in Iraq.","authors":"Ghazwan A Baghdadi, Firas Mohammed Zaki, Ihab Raqeeb Aakef, Hussein Gatea Oudah, Shamsulddin Ahmed, Muhammad Hussein Abdulhadi","doi":"doi.org/10.26719/2026.32.4.206","DOIUrl":"doi.org/10.26719/2026.32.4.206","url":null,"abstract":"<p><strong>Background: </strong>Rabies is a fatal acute viral encephalitis that remains a public health problem in Iraq. There is continuous reported transmission nationwide.</p><p><strong>Aim: </strong>To describe the epidemiology of reported rabies cases from 1997 to 2024 among humans in Iraq.</p><p><strong>Methods: </strong>We collected data on all reported probable cases of rabies among humans for 1997-2024, from the Iraq national rabies surveillance database. We analysed the data using SPSS version 27 and Microsoft Excel 2019, and calculated the incidence rates per 10 million population.</p><p><strong>Results: </strong>A total of 437 rabies cases were reported during the period, with an annual mean of 15.6 ± 6.6 cases. Cases occurred throughout the year, with a relative peak between May and October. The highest number of cases was reported in 1999 (30 cases; 6.9%) and the lowest was in 2015 (6 cases; 1.4%). Most cases occurred among children aged <15 years (60.2%), and males accounted for 82.2% of cases. The highest incidence rates per 10 million population were reported in the central and southern governorates, particularly Babylon (11.18) and Diyala (10.99).</p><p><strong>Conclusion: </strong>Iraq continues to report a high number of rabies cases among humans annually. To achieve the WHO target of eliminating rabies among humans by 2030, there is a need for more effective rabies control measures, including better stray dog population management, expanded animal vaccinations, improved public awareness, and continuous access to rabies vaccines and immunoglobulin.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"206-211"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year analysis of antibiotic consumption at university teaching hospitals in Tunisia.","authors":"Asma Mhiri, Manel Turki, Youssef Zanina, Himanshu A Gupte, Garry Aslanyan, Collins Timire, Abubaker Suliman, Hela Ghali, Samiha Toumi, Aida Jarraya, Aimen Abbassi, Khouloud Ben Jeddou, Balsam Kacem, Taoufik Borji, Houyem Laatiri, Myriam Khrouf, Abderrazek Hedhili","doi":"doi.org/10.26719/2026.32.4.188","DOIUrl":"doi.org/10.26719/2026.32.4.188","url":null,"abstract":"<p><strong>Background: </strong>A national antimicrobial consumption reporting system has been established in Tunisia, however, regional, hospital and departmental data on consumption remain limited.</p><p><strong>Aim: </strong>To assess annual antibiotic consumption trends in Tunisia's university teaching hospitals from 2018 to 2022.</p><p><strong>Methods: </strong>We analysed data on antibiotic consumption for 2018 to 2022 by patients aged ≥18 years admitted into 5 university teaching hospitals in Tunisia, based on the WHO defined daily doses per 1000 inhabitants per day and the access, watch and reserve classification. We assessed the differences between year, region, specialty and antibiotic classifications using the Friedman test. P ≤ 0.05 was considered statistically significant.</p><p><strong>Results: </strong>There was no significant difference in antibiotic consumption between the 5 hospitals over the 5-year period (P = 0.455). However, there were consistent significant differences between hospitals in the different regions and between antibiotic categories. There were significant differences in antibiotic consumption between the different hospital departments. The highest consumption was observed in the intensive care units (increasing from 154.2 defined daily doses per 1000 inhabitants per day in 2018 to 174.9 in 2022), which also had the highest increase in the consumption of reserve antibiotics (12.6% in 2018 to 16.7% in 2022).</p><p><strong>Conclusion: </strong>The relatively stable antibiotic consumption observed in our study does not imply appropriate use. There is a need for robust antibiotic use surveillance systems in Tunisian hospitals, especially in intensive care units, alongside targeted interventions to effectively address antimicrobial resistance.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"188-196"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resurgence of measles in Bosnia and Herzegovina amid declining vaccination coverage.","authors":"Anes Jogunčić, Asaf Salčinović, Aida Pošković-Bajraktarević, Agnesa Porović-Hodžić, Anisa Bajramović, Alma Bungur, Emina Kurtagić Pepić, Snežana Bursač Aranđelović, Zlatan Hamza","doi":"doi.org/10.26719/2026.32.4.219","DOIUrl":"doi.org/10.26719/2026.32.4.219","url":null,"abstract":"<p><strong>Background: </strong>Sarajevo Canton reported large measles outbreaks in 2019 and 2024, highlighting the impact of the persistent gaps in immunisation coverage.</p><p><strong>Aim: </strong>To analyse 2 measles outbreaks in Sarajevo Canton in Bosnia and Herzegovina, identify populations at risk and assess the impact of vaccination coverage on disease transmission.</p><p><strong>Methods: </strong>We collected publicly available weekly case counts data for 45 weeks from the Public Health Institute of Sarajevo Canton and examined the vaccination coverage for 5 years to assess the impact of immunisation on outbreak dynamics. We conducted descriptive analyses using RStudio version 2024 and evaluated the differences between outbreaks using Mann-Whitney U test. P < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 869 cases were reported in 2019 and 4505 in 2024, and children aged 1-4 years were mostly affected (42.1%). Most of the cases were either unvaccinated or had unknown vaccination status; 92.3% of cases in 2019 were unvaccinated, and 87.7% in 2024 were unvaccinated, while 9.9% had unknown vaccination status. The 2024 outbreak had a higher and longer peak (416 vs 91 cases) occurence than 2019, and one death was reported in each year.</p><p><strong>Conclusion: </strong>The declining vaccination coverage in Sarajevo Canton contributed to increased measles incidence. Strengthening mandatory immunisation, targeted catch-up campaigns and public communication are essential to achieve herd immunity, prevent future outbreaks and progress towards Universal Health Coverage.</p>","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"219-224"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential and pitfalls of artificial intelligence application in medical diagnostics.","authors":"Ahmed Ouaamr, Katim Alaoui","doi":"10.26719/2026.32.4.179","DOIUrl":"https://doi.org/10.26719/2026.32.4.179","url":null,"abstract":"","PeriodicalId":93985,"journal":{"name":"Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit","volume":"32 4","pages":"179-181"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}