Our results confirm the substantial and increasing pneumococcal infection, the emerging of multidrug resistant isolates, and the vulnerability of the younger age group and high-risk population, which calls for a national surveillance to inform policy and decision-making before national wide vaccine introduction.

Background: Exposure of women to socioeconomic risks, as becoming the head of the family, could influence their life quality. Therefore, assessment of women's needs in families headed by women (FHW)to achieve equity regarding health-related quality of life (HRQoL) is pivotal for stakeholders involved in women's programs. Objective: to identify the predictors of HRQoL of young women heading their families versus young wives in families headed by men (FHM). Methods: A community-based cross-sectional study compared the HRQoL for two groups of women (age is 25-49 years); 200women heading their families (group 1) and 200 wives in FHM (group 2). The study was conducted in a randomly selected shiakha (El-Atrees Shiakha) in El-Saida Zeinab district in Cairo, Egypt using structured interview questionnaire form. Results: Women heading their families who had significantly (p< 0.05) lower mean HRQoL score compared to wives in FHM were those ≥35 years old, non-educated and those with history of early marriage (mean HRQoL scores ± standard deviations were 3.5±0.6, 3.5±0.56, 3.4±0.6 respectively).Conclusion: women having socioeconomic risks related to 'non-education, young age at marriage and working in unstable jobs" were more vulnerable to suffer from low HRQoL upon exposure to the socioeconomic crises of becoming the head of the family.

Background: In Egypt, primary healthcare workers (PHCWs) often work in challenging situations and in relative isolation from the health system and specialists' experiences. Supervision is currently applied by PHCWs to present practice, control and upgrade knowledge and skills. Objectives: To assess the current supervision system in the Ministry of Health and Population (MOHP) at the central, governorate, district, and primary healthcare (PHC) facility levels. Methods: The research setting is the MOHP-PHC head quarter (HQ) and five governorates. Design: Cross-sectional analytical observational health system research qualitative and quantitative study of Egyptian health service and operations. Sampling: The multistage sampling technique was used to select districts (n ¼ 25) units (n ¼ 250), physicians (n ¼ 250), and nurses (n ¼ 250) from five randomly selected governorates that represent four Egypt regions. Data collection: Focus group discussions (FGDs) and selfadministered questionnaires. Results: Response rate to questionnaires were in total 73% (67% for physicians and 80% for nurses). FGDs demonstrated that PHC has an effective supervision system at central, governorate, and district levels. The effective supervision allowed overcoming barriers related to the shortage in PHCWs needed to cover 5364 PHC units in addition to mobile clinics. Supervisors use a standardized

OBJECTIVES: The objectives of the study were to assess clinical supervision (CS) role in quality family planning/reproductive health services (FP/RHS) in Ministry of Health and Population-primary health care (MOHP-PHC) facilities through objective analysis. METHODS: Settings: MOHP and five Egyptian governorates. Design: A qualitative study with objective analysis that covers strengths and sustainability. Sampling: Random sample of 25 districts and 250 health units (one physician and one nurse from each unit) from five governorates. Data collection: Focus group discussions (FGDs) (n = 21) for clinical supervisors at central, governorate, and district levels. RESULTS: FGDs raised vital roles of CS in FP/RHS. Clinical supervisors were dissatisfied because they are not partners in decision making in MOHP training programs. CONCLUSION: CS in FP/RHS is important for sustainable capacity building of the service providers teams in PHC facilities.

BACKGROUND: The study is of practical importance for policy makers and family planning (FP) program managers as the profile of FP method-mix with a shift from a mechanical method as intrauterine devices (IUD) to hormonal methods such as oral contraceptives (OCs) and injectables predicts a critical situation for maternal and child health and reflects shortcomings in FP service delivery program. AIM: The purpose of the current study was to identify reasons for the progressive shift from IUD to OCs in Egypt. METHODS: The study is an-operations research conducted at four levels of the Ministry of Health and Population/FP (MOHP/FP) service delivery: Central (headquarter, HQ), governorate, district, and service delivery points. It included five of MOHP/United Nations Fund for Population Activities-Contraceptive Security Project governorates that represent, urban governorates, Lower Egypt, and Upper Egypt. Both qualitative data in-depth interviews with MOHP/HQ staff, Two Focus Group Discussions with FP Health Directorates staff and nurses in the five governorates, and quantitative data through a self-administered questionnaire for 607 service providers (SP). RESULTS: There was a consensus on the actual shift from IUD to OCs use. Reasons were the absence of incentives for healthcare providers for IUD insertion services (64%) and improper training of physicians (45%), and the availability of OCs all time. CONCLUSION: The three articulating issues that lead to shifting from IUD to OCs are: Unsatisfactory training and incentive systems for SPs and the clients’ choice of OCs for independent use/autonomy, and availability of OCs all the times at a reasonable cost in both the public and private sectors.

Background: Egypt's Ministry of Health and Population (MOHP) has 5364 Family Medicine Facilities (FMF) encompassing family folders (FF) with detailed medical information about family members. However, there is no health information system at the facility level to provide community morbidity statistics, especially about chronic communicable and noncommunicable diseases (NCD). Objectives: Develop statistical module centering on the risk factors associated with chronic diseases among families encompassed in family center folders. Methods: The study was done in a Family Medicine Center (FMC) in Giza. A sample of 2169 FFs forming 54% of the total available FFs in this center was selected by systematic random sampling technique. A software excel program was designed to include 8 sheets to integrate the data registered in 16 forms distributed in 32 pages with subsequent analysis of these data on chronic diseases. Results: The collected data were about 10477 individuals in 2169 FFs. The proportions of individuals diagnosed with chronic diseases were as follows: 51.9% diagnosed with diabetes mellitus, 26.2% with hypertension, 6% with cardiac diseases, 3.7% with renal diseases, 3.4% with psychological disorders, 2.1% with epilepsy, 1.3% with neurological disorders, 1.2% with liver diseases, 1.1% with blood diseases, 0.9% with asthma, 0.3% with bone diseases, 0.2% with skin diseases, and 1.8% with tuberculosis. There were statistically significant differences (p< 0.01) between the proportion of cases in terms of crowding index, age, sex, education, work status, and habits. Conclusion: The study provided a module of 8 forms including data from 32 pages of the family folders. This module allows the statistical analysis of the risk factors associated with chronic diseases among families registered in the FMF. Scaling up of this module across FMFs could guide service providers to support the at-risk families.