Despite the great realized or potential value of network meta-analysis of randomized controlled trial evidence to inform health care decision making, many decision makers might not be familiar with these techniques. The Task Force developed a consensus-based 26-item questionnaire to help decision makers assess the relevance and credibility of indirect treatment comparisons and network meta-analysis to help inform health care decision making. The relevance domain of the questionnaire (4 questions) calls for assessments about the applicability of network meta-analysis results to the setting of interest to the decision maker. The remaining 22 questions belong to an overall credibility domain and pertain to assessments about whether the network meta-analysis results provide a valid answer to the question they are designed to answer by examining 1) the used evidence base, 2) analysis methods, 3) reporting quality and transparency, 4) interpretation of findings, and 5) conflicts of interest. The questionnaire aims to help readers of network meta-analysis opine about their confidence in the credibility and applicability of the results of a network meta-analysis, and help make decision makers aware of the subtleties involved in the analysis of networks of randomized trial evidence. It is anticipated that user feedback will permit periodic evaluation and modification of the questionnaire.

The evaluation of the cost and health implications of agreeing to cover a new health technology is best accomplished using a model that mathematically combines inputs from various sources, together with assumptions about how these fit together and what might happen in reality. This need to make assumptions, the complexity of the resulting framework, the technical knowledge required, as well as funding by interested parties have led many decision makers to distrust the results of models. To assist stakeholders reviewing a model's report, questions pertaining to the credibility of a model were developed. Because credibility is insufficient, questions regarding relevance of the model results were also created. The questions are formulated such that they are readily answered and they are supplemented by helper questions that provide additional detail. Some responses indicate strongly that a model should not be used for decision making: these trigger a "fatal flaw" indicator. It is hoped that the use of this questionnaire, along with the three others in the series, will help disseminate what to look for in comparative effectiveness evidence, improve practices by researchers supplying these data, and ultimately facilitate their use by health care decision makers.

Worldwide, health care decision makers are challenged to set priorities in an environment in which the demand for health care services outweighs the allocated resources. Effective pharmaceutical pricing and reimbursement systems, based on health technology assessment (HTA) that encompasses economic evaluations, are essential to an efficient sustainable health care system. The Egyptian Ministry of Health and Population was encouraged to establish a pharmacoeconomic unit, as an initial step, for the support of pricing and reimbursement decisions. We anticipate that standardization of reporting would lead to a progressive improvement in the quality of submissions over time and provide the Egyptian health care system with health economic evidence often unavailable in the past. Therefore, recommendations for pharmacoeconomic evaluations provide an essential tool for the support of a transparent and uniform process in the evaluation of the clinical benefit and costs of drugs that do not rely on the use of low acquisition cost as the primary basis for selection. These recommendations will help inform health care decisions in improving health care systems and achieving better health for the Egyptian population.

Malnutrition is an increasing health problem among children in developing countries. We assessed the level of malnutrition and associated factors among school children in a rural setting in Fayoum Governorate, Egypt. A school based cross-sectional survey was conducted on children (6–17 years) in Manshit El Gamal village in Tamia district of Fayoum Governorate. Weight, height, and age data were used to calculate z-scores of the three nutritional indicators using WHO anthroPlus. Sociodemographics and lifestyles Data were collected. Prevalence of stunting, underweight, and wasting was 34.2%, 3.4%, and 0.9%, respectively, while obesity was 14.9%. Prevalence of obesity was significantly higher in younger age group of 6–9 years in comparison with older age and was higher in males versus females in 10–13-year-age group. Increasing age, reduced poultry consumption, and escaping breakfast were associated factors for stunting with OR (95% CI) 1.27 (1.17–1.37), 2.19 (1.4–3.4), and 2.3 (1.07–5.03). Younger age and regular employment of the father were factors associated with obesity (OR = 0.753; 0.688–0.824 and OR = 2.217; 1.4–3.5). Malnutrition is highly prevalent in Fayoum in line with the national prevalence and associated with age, gender, regularity of father's employment, and dietary factors.

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Background: Breast cancer is the most common cancer among women worldwide and it is the most prevalent cancer among Egyptian women. The very important factor in the prevention of progression of it is increasing the breast cancer awareness. Objectives: to asses level of knowledge on breast cancer risk factors and breast selfexamination and also to determine if BSE is practice by target population and its attitude towards it. Conclusion: few of our participants had very good knowledge about breast cancer risk factors. Although they have satisfactory attitude they do not perform BSE and the main reason for not performing BSE is the lack of specific training programs.

The present study is the first cost-utility analysis to conclude that, from the perspective of Egyptian medical providers, combined therapy is more effective and less costly than warfarin alone for patients with mechanical aortic valve prostheses. For clinicians and patients who choose to focus on minimizing thromboembolic risk, these results suggest that combined therapy offers the best protection. This study helps to inform decisions about the allocation of health care system resources and to achieve better health in the Egyptian population.

Background Unsafe injection necessitates some preventive steps including promoting and assuring the execution of safe injection administration and waste disposal methods. The present study aimed to assess the awareness and practices of safe injection among health care providers working at all primary health care (PHC) facilities in Fayoum governorate, Egypt. Also, it assessed the awareness, readiness, and response related to needle stick injuries (NSIs). Methods A cross-sectional observational study conducted from September to December 2019 at all working PHC facilities in Fayoum Governorate, Egypt, resulted in enrolling 685 health care providers, and observation of 520 injection processes. Data were collected by a combination of staff interviews and structured observation of different injection processes using the WHO revised C tool. Results Safe injection and post-exposure NSI policies and procedures was implemented in 96.5% of the PHC facilities. Compliance to hand wash before preparing a procedure was 56.7%. Immediate disposal of used needles was 76.2% in observed injections. Hepatitis B vaccination rate among participants was 87.2%. Most participants 87.6% admitted the existence of a NSI reporting system but only 38.8% of those who had experienced NSI event reported. The rate of NSI was 14%. Conclusions Fayoum PHC facilities have good awareness level among providers and broadly accepted compliance with injection practices as per the WHO tool. Most injection-safety aspects were satisfactory, and implemented measures to face NSI were in place. Appropriate timely actions are required to maintain the fair awareness and improve injections practices in the PHC facilities.