ObjectiveVerbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems.MethodsA literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification.FindingsA revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach.ConclusionsThe revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.

Background: Postpartum women are a priority group to target on trying to solve the problem of closely spaced pregnancies as well as population explosion. Aim: To estimate the level of unmet need for postpartum family planning one year after birth as well as identify factors associated with having unmet need in Alexandria, Egypt. Methods: A cross sectional survey was adopted. A sample of 1500 women one year post-partum was selected. A predesigned interviewing questionnaire was used to collect data. Data include their sociodemographic characteristics and current use of family planning method. Those with unmet need for postpartum family planning (PPFP) were asked about the reasons for non-use, their intention to use in the future and their knowledge about contraceptives. Setting: Public settings delivering routine immunization for infants in Alexandria. Results: Out of 1500 postpartum women, 1370 (91.33%) have a real demand for family planning. Out of those with a real demand for family planning (n = 1370), 1106 (80.72%) were using a modern contraceptive method and only 41 (3%) were using a traditional method for birth control while the remaining 223 (16.28%) were having unmet need for postpartum family planning. Amenorrhea, breast feeding, fear of side effects, discontinuation due to health concerns and pressure from the surroundings were the most common cited reasons for non-use. Conclusion:Integration of family planning education during antenatal, natal and postnatal care services in Egypt should be actively initiated. Women with unmet need for PPFP in general and those with intention to use a contraceptive in particular should be targeted for recruitment efforts and services in any program tackle the problem of family planning and rising fertility in Egypt.

Background: Patient safety is a critical component of healthcare quality. This study aimed at assessing the perceptions of primary healthcare staff members about patient safety culture and explores the areas of deficiency and opportunities for improvement concerning this issue. Methods: This descriptive cross sectional study surveyed 328 staff members in 28 primary healthcare facilities in Alexandria using an anonymous direct structured interview format of a modified “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 250 participants (response rate = 76.2%). The main outcome measures include patient safety culture score including sub scores on 12 dimensions and 42 items; patient safety grade, number of events reported and factors contributing to the adverse events. Results: The overall median% score for perception of patient safety culture at the facility level was 68.6%. After controlling of the confounders; being female respondent, being physicians or nurses or midwives, having long experience in PHC service and receiving education and training about safety issues were positively associated with positive response on patient safety culture scale. The domains with the highest positive score and are thus considered areas of strength were teamwork within units (80.0%), management support for patient safety (80.0%), supervisor expectations and actions promoting patient safety (75.0%) and handoffs and transitions (75.0%). Dimensions scoring the lowest and as such can be considered areas requiring improvement were overall perceptions of patient safety, frequency of events reported and staffing (60% give positive response for each). More than two-fifths (43.6%) did not report any events in the 12 months preceding the survey. The difference between professions regarding the most common procedure that causes adverse event is statistically significant. Patients' related factors such as ignorance and socio cultural acceptance were reported to be the most common factors contributing to the adverse events (92.4% of the studied participants reported that). Conclusions: Improving patient safety culture should be a priority among health center administrators. Healthcare staff should be encouraged to report errors

Background: Since identification of the first case on Feb. 14, Egypt had implemented several control measures. This research aimed at study the time trend of the transmissibility and mortality of COVID 19 in Egypt. Methods: Published data on daily reported cases and deaths since the start of the epidemic till week 19 were used. We estimated the basic reproductive number (R 0) during the early phase of the epidemic using the simple exponential growth method (SEG) and time dependent method (TD). Then we estimated time varying effective reproductive number (R e) after implementation of the control measures by applying the TD method. Moreover, the trend in the Case Fatality Rate (CFR) throughout the study period was studied. Results: With SEG method, R 0 was found to be 2.26 (2.15-2.38) and 2.58 (2.43-2.72) for infectious period of 8 and 10 days, respectively. While by the TD method, R 0 was estimated to be 2.34 (95% CrI: 2.05-2.64) and 3.01 (95% CrI: 2.64-3.40) for mean ± SD of SI equals 5.8 ± 2.6 and 7.5 ± 3.4, respectively. With TD method, R e decreased from the initial value of R 0 to reach 1.30 (95% crI: 1.17-1.45) in week 7. After that R e values fluctuated closely around 1. CFR reached its peak (7.7%) on April 12 then it decreased to its lowest value (3.4%) after two months before increasing slightly again to (4.1%) in the last days. Conclusion and recommendation: The initial Basic reproductive number was high in Egypt. Effective reproductive number dropped after control measures till fluctuating around one. CFR also declined over time but slight increase in the last days was observed. After relaxation of the control measures, we recommend the instantaneous monitoring of the transmissibility and mortality in Egypt.

Background: A national vaccination campaign for measles and rubella (MR) was conducted in Egypt in the period from October 31 st to November 21 st , 2015, across Egyptian governorates by the Ministry of Health and Population (MOHP), in collaboration with World Health Organization and UNICEF. It targeted 24 million children aged 9 months to 10 years. Objectives: The present survey aimed at evaluating coverage of the MR national vaccination campaign, to identify the gaps and generate sound recommendations for the upcoming campaigns. Methods: A cluster survey was conducted targeting children aged 9 months to less than 10 years. This household survey was carried out in 26 governorates of Egypt. In each governorate 240 interviews were completed. Results: The survey revealed that the campaign achieved an overall coverage of 98.2% compared to 109.8% vaccination coverage as reported by the Ministry of Health (MOH). Some clusters showed below target coverage in a couple of governorates (Port Said 93.3% and Qena 93.8%). Nonvaccinated children constituted 1.8% of all surveyed children. When causes of non-vaccination were enquired about, the most frequently mentioned cause was ignorance of parents about the vaccination campaign (43 children, 38.1%). Conclusion: The MOHP implementation of the national MR campaign was successful and achieved its objective for increased coverage with MR vaccine among the target age group.

Background: Molecular targeted drugs are the first line of treatment of advanced hepatocellular carcinoma (HCC) due to its chemo and radio resistant nature. HCC has several well documented etiologic factors that drive hepatocarcinogenesis through different molecular pathways.  Currently, Hepatitis C virus (HCV) is a leading cause of HCC. Therefore, we included a unified cohort of HCV-genotype 4 related HCCs to study the expression levels of genes involved in the Insulin-Like Growth Factor 1 Receptor (IGF1R) pathway, which is known to be involved in all aspects of cancer growth and progression. Aim: Determine the gene expression patterns of IGF1R pathway genes in a cohort of Egyptian HCV-related HCCs. Correlate them with different patient/tumor characteristics. Determine the activity status of involved pathways. Methods: Total RNA was extracted from 32 Formalin fixed paraffin embedded tissues of human HCV-related HCCs and six healthy liver donors as controls. qRT-PCR using RT2 Profiler PCR Array for Human Insulin Signaling Pathway was done to determine significantly up and downregulated genes with identification of most frequently coregulated genes.  Followed by correlation of gene expression with different patient/tumor characteristics. Finally, Canonical pathway analysis was performed using the Ingenuity Pathway Analysis software. Results: Six genes; AEBP1, AKT2, C-FOS, PIK3R1, PRKCI, SHC1 were significantly overexpressed. Thirteen genes; ADRB3, CEBPA, DUSP14, ERCC1, FRS3, IGF2, INS, IRS1, JUN, MTOR, PIK3R2, PPP1CA, RPS6KA1 and VEGFAwere significantly under expressed. Several differentially expressed genes were related to different tumor / patient characteristics. Nitric oxide and reactive oxygen species production pathway was significantly activated in the present cohort, while the growth hormone signaling pathway was inactive Conclusion: The gene expression patterns identified in this study may serve as possible therapeutic targets in HCV-related HCCs. The most frequently coregulated genes may serve to guide combined molecular targeted therapies. The IGF1R pathway showed evidence of inactivity in the present cohort of HCV-related HCCs, so targeting this pathway in therapy may not be effective.

No abstract

No abstract