Faris Lami

Background Comorbidities pose a major clinical challenge to the care and treatment of patients with COVID-19. Objective This study aimed to evaluate the effects of common comorbidities on the severity, outcome, and length of stay in the hospital for patients with COVID-19 in Babel Governorate, Iraq, in 2020. Methods All laboratory-confirmed cases of COVID-19 in the 2 COVID-19 hospitals in Babel Governorate from March through September 2020 were included. We developed a form to document sociodemographic data, clinical presentation, severity, comorbidities, length of hospital stay, and outcomes. Results  A total of 2574 patients were included; 1581 (61.4%) were men. The mean age was 48.7 (SD 16.4) years. There were 1212 (47.1%) severe cases and 489 (19%) critical cases. There were 1543 (59.9%) patients with no comorbidity, 536 (20.9%) patients with 1 comorbidity, and 495 (19.2%) patients with 2 or more comorbidities. The most common comorbidity was diabetes mellitus (643/1599, 25%), f...

BACKGROUND A higher incidence of COVID-19 in males has been widely reported. However, whether clinical manifestations, comorbidities, severity, and outcomes differ between males and females remains an area of active investigation. OBJECTIVE We aimed to compare the clinical features, comorbidities, severity, and outcomes between male and female patients with COVID-19 from Baghdad, Iraq, in 2020. METHODS We performed a records-based cross-sectional study by extracting sociodemographic, clinical manifestation, severity, and outcome data from the records of patients with COVID-19 admitted to 2 COVID-19 hospitals in Baghdad, Iraq, between June and August 2020. RESULTS We reviewed a total of 2111 patient records with a history of COVID-19, and 1175 (55.7%) patients were males. We found that respiratory symptoms, sore throat, and gastrointestinal manifestations were significantly more common among females. In contrast, males had significantly more “other” manifestations. No significant dif...

Background Iraq has been exceptionally challenged by the COVID-19 pandemic due to the already exhausted healthcare system. Objectives To describe the epidemiological situation of COVID-19 in Iraq, the government’s response to the pandemic, and provide recommendations for further action. Methods A desk review of secondary data using the available reports on the epidemiological situation in Iraq as well as official governmental sources was conducted. Results The major surge in the number of COVID-19 cases occurred in the first week of June and continued to increase dramatically until mid-October when a significant decrease happened. With a few exceptions, the reproductive number R has been consistently above 1. Patients aged 30–39 years (25.6%) were the most affected, while those aged 60–69 years (26.7%) had the highest deaths rates. Iraq tried to contain the pandemic through several regulations: border control, enforcing curfew, mask-wearing, and social distancing, COVID-19 isolation...

In recent years, noncommunicable diseases (NCDs) have globally shown an increasing impact on health status with disproportionately higher rates in developing countries. During the outbreak, health workers, equipment, and facilities have been reallocated to address the influx of patients with COVID-19. Restructuring of the health system could result in the closure of some health facilities. The aim of this paper was to determine the impact of COVID-19 on the performance of NCD programs implemented in the primary health care centers in Al-Rusafa DOH through comparing the performance indicators of 2019 and 2020, and to identify the potential causes of the changes. The study was conducted in Baghdad, Al-Rusafa, during the period from April to June 2021. A systematic sample was used to enroll 20 primary health care centers. The descriptive analysis focused on frequencies and percentages. Continuous variables are presented as mean (SD), and the independent t test was used to assess statis...

Background The SARS-CoV-2 infection produces detectable immune responses in most cases reported to date. A serological test could capture previous asymptomatic infections and help to assess the immune status of a subject. Health care workers are highly vulnerable to COVID-19 infection, and providing personal protective equipment is the primary strategy to prevent disease transmission within the health care setting. Objective The aim of this paper was to determinate the seroprevalence of COVID-19 among health care workers in primary health care centers in the AL-Sader city district. Methods A cross-sectional study was conducted in 9 primary health care centers, which were selected using a cluster random sampling technique from November 1, 2020, to December 31, 2020. Results A total of 470 participants were enrolled in the study; 101 (21.5%) of them had a history of COVID-19 infection, and 76 (16.1%) were diagnosed by polymerase reaction chain. There was a significant association betw...

The study objective was to estimate the rate of adherence to treatment among depression patients, and to determine the possible factors in non-adherent. We sampled 337 random participants of Iraqi descent, who live in Michigan. Of all the participants, 93 reported forms of depression. Of those 93 people, 36.6% are non-adherent to anti-depressants. There were significant differences among those who are adherent with treatment and those who were not. We noted that Participants with chronic disease were adherence to treatment of chronic illness more than adherence to antidepressants. A non-adherent participant tends to have poorer health compared to his or her health in the previous year. In conclusion the prevalence of medication adhering participants was 63.4%. Key Words : Depression , Adherence, Chronic diseases, Self-rated health, Arabs, Chaldeans

Background Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors. Methods A multi-country cross-sectional study was conducted during July–August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Results A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. ...

Objectives The objective of this study was to assess the resilience of health systems in four governorates affected by conflict from 2014 to 2018, and to convey recommendations. Methods Health managers from Al Anbar, Ninawa, Salah al-Din, and Kirkuk governorates discussed resilience factors of Primary Health Care services affected by the 2014–2017 ISIS insurgency in focus groups, and general discussions. Additional information was gathered from key informants and a UNICEF health facility survey. Three specific aspects were examined: (1) meeting health needs in the immediate crisis response, (2) adaptation of services, (3) restructuring and recovery measures. Data from a MoH/UNICEF national health facility survey in 2017 were analyzed for functionality. Results There were many common themes across the four governorates, with local variations. (1) Absorption The shock to the public sector health services by the ISIS invasion caught health services in the four governorates unprepared, ...

Background There is no prior study of the effect of mobility-limiting measures on the occurrence of COVID-19 in Iraq. Objectives To determine the relationship between publicly available mobility index data and the growth ratio (GR) of COVID-19. Method We used Google COVID-19 Community Mobility Reports to extract Iraq’s mobility data and the official Ministry of Health COVID-19 statements. We used the data to calculate the Pearson’s correlation coefficient and fit a linear regression model to determine the relationship between percentage change from the baseline in the mobility indices and the GR of COVID-19 in Iraq. Results There was a moderate positive correlation between each of the mobility indices except the residential index and COVID-19 GR in Iraq. The general linear model indicated that as each of the mobility indices increases by one unit, the GR of COVID19 increases by 0.002–0.003 except for the residential index. As the residential mobility index increases by one unit, the...

Background This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained). Methods Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs. Results Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was l...

Background In 2018, an outbreak of cutaneous leishmaniasis (CL) occurred in Diyala Province in Iraq. Several risk factors of CL were identified in a prior study; however, the impact of removing modifiable risk factors on the occurrence of the disease was not measured. Objective The aim of this study is to measure the impact of removing modifiable risk factors of CL on the occurrence of the disease. Methods We conducted a population-based unmatched case-control study in two conveniently selected districts in Diyala Province. All cases of CL were included. Controls were chosen preferentially according to the site where the cases occurred. A structured questionnaire was used to collect data. The unadjusted odds ratios (ORs) and 95% confidence intervals for each risk factor were calculated using binary logistic regression. We also calculated the attributable fractions and 95% confidence intervals of the modifiable risk factors. A P value

BackgroundWhile there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.MethodsIn this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.ResultsGBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in te...

Background: Irritable Bowel Syndrome (IBS) is a common chronic functional gastrointestinaldisorder characterized by abdominal pain or discomfort and alteration in bowel habits. It is morecommon among adolescents and young age groups.Objectives: to estimate the prevalence and identify potential determinants of IBS among high schoolstudents in Baghdad, Iraq, 2017.Methods: This cross-sectional study was conducted by using multi-staging cluster probabilitysampling technique. All students in the sixth grade were considered eligible. Students with…

BackgroundPast research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.MethodsWe reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).FindingsIn 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty...

BackgroundThe epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.MethodsInjury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm—the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational...

UNSTRUCTURED 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 ...

Background Arbaeenia is the largest religious mass gathering in Iraq. The conditions associated with mass gatherings result in high rates of injury. There have been no prior studies on injuries during the Arbaeenia mass gathering. Objective This study describes the injuries observed during the Arbaeenia mass gathering in Babel Governorate in Iraq between November 24 and December 14, 2014. Methods The study was conducted in Babel Governorate at the emergency departments of six public hospitals and two major temporary medical units that were located along the three roads connecting the Middle and Southern Iraqi governorates. We used the Iraq Injury Surveillance System modified form to collect information on injured patients treated in the selected facilities. Data on fatal injuries was obtained from the coroner’s office. The following data were collected from the patients: demographics, outcome of injury, place and time of occurrence, mode of evacuation and medical care before arrivin...

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geograp...

BACKGROUND Millions of pilgrims attend Arbaeenia mass gathering (MG) in Iraq each year. Thousands of individuals work voluntarily at temporary rest areas (locally called Mawakib), distributed in most of Iraq governorates, to provide food and other services to the MG attendees. The potential for improper handling of food at Mawakib increases the risk of waterborne and foodborne diseases. OBJECTIVE This study was aimed to assess the knowledge, attitude, and practices (KAP) of food handlers in Mawakibs in Baghdad city during Arbaeenia MG. METHODS A random sample of 100 Mawakibs was selected in Baghdad, 50 from the eastern side (Rusafa) and 50 from the western side (Kerkh), and five food handlers were randomly selected from each Mawakib. A questionnaire was used to collect demographic data and KAP for food safety and personal hygiene. The questionnaire included 25 questions addressing knowledge, 10 addressing attitudes, and 14 addressing practices of the food handlers with respect to fo...

BACKGROUND The Arbaeenia mass gathering (MG) in Karbala is becoming one of the largest MGs in the world. The provision of basic health care and emergency services is essential to the safety of MG attendees. The local health infrastructure in Iraq struggles to meet the needs of the local community and is ill-prepared to serve the health needs of the millions of participants in the Arbaeenia MG. OBJECTIVE To describe the temporary health care facilities installed and run by local community to provide health care services for the Arbaeenia MG attendees in Karbala, Iraq. METHODS Methods: We conducted this survey on all community-based health care facilities located along the last 22 kilometers (within Karbala official boundaries) of the road from Najaf to Karbala. A structured questionnaire used and filled through interviews with the health workers and direct observations. We collected information on the facilities, staff profile, type of services provided, and inventory of medical equipment, drugs and supplies besides basic information on infection control measures. RESULTS Results: In total, 120 health facilities, staffed by 659 health workers were assessed. Only 15% (18) of the facilities were licensed by the MOH and 44% of health workers were health professionals. The medical services provided by the health workers included dispensing drugs (22%), caring for wounds/injuries (18%), measuring blood pressures/ blood sugar (21%) and giving injections (17%). Most of the medical problems encountered were musculoskeletal (97%); the least common problem treated was injuries (17%). The drugs available in the clinic were analgesics, drugs for gastro-intestinal and respiratory diseases, and antibiotics, with a range of 13%-100%. The average availability of these drugs in the facility was 7.3, on a scale of 10. Infection control practices existed in these facilities for individual protection, environmental sanitation, and medical waste disposal, with a range of 18%-100%. Most commonly available medical equipment was sphygmomanometer (72%), glucometer (70%) and stethoscope (63%). CONCLUSIONS Conclusion: In spite of the shortage of trained human resources and inadequate basic medical equipment, drugs and supplies; community- based health facilities can significantly contribute to provide health care services to MG attendees. Iraq MOH is requested to ensure licensing of these facilities after ensuring fulfillment of the necessary standards.  

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 con...

Background Millions of Iraqi pilgrims travel annually from the southern governorates to Karbala and pass through Thiqar, Muthana, and Diwania Governorates to join the Arbaeenia mass gathering event. During this event, participants are at high risk for diseases and death and stifle local health care resources. In addition, the mass gathering causes considerable burden on health facilities in the hosting localities. Objective This study aims to estimate the disease burden on health facilities caused by the pilgrims passing through Thiqar, Muthana, and Diwania Governorates en route to Karbala in Iraq. Methods This cross-sectional study was conducted on all health facilities in three governorates (Thiqar, Muthana, and Diwania) situated along the southern way to Karbala from Basra. The study started on December 11, 2014, and ended on December 24, 2014. The morbidity and mortality were collected from surveillance logbooks and death registers. Drug purchase data were obtained from the pers...

This study aimed to estimate the prevalence and determinants of mental disorders (MDs) among elderly people residing in nursing homes (NHs) and those living with their families (WF) in Baghdad, Iraq, 2017. A cross-sectional study was conducted on all elderly individuals residing in all NHs in Baghdad and an equal number of elderly people residing WF. MDs were defined based on Kessler Psychological Distress Scale (K10). We used relevant World Health Organization–accredited tools to identify the types of MDs. The prevalence of MDs among elderly people was 38.7%, being statistically significantly ( P < .01) higher among those in NH (55.8%) compared with those living WF (21.5%). The proportion of types of MDs among NH versus WF residents was as follows: depression (35.4% vs 16.6%), anxiety (32.6% vs 9.9%), dementia (19.3% vs 5%), and suicide thoughts (25.4% vs 4.4%). The multivariate analysis showed many factors that were associated with MD. Low income, dependency on others, and bein...

Hemophilia is an inherited bleeding disorder that mainly affects males. Globally, there are about 400 000 people with hemophilia and only 25% of them receive adequate treatment. There is insufficient epidemiological data on hemophilia in Iraq; so, this study was conducted to determine the trend of the prevalence and incidence and to identify certain clinical and epidemiological characteristics of patients with hemophilia in Baghdad, Iraq, 2016. This cross-sectional study was conducted in the 4 hemophilia centers in Baghdad. The data were compiled by reviewing all hemophilia patients’ records and the centers’ registry books between 2007 and 2016. Corresponding population data of Baghdad were obtained from the Ministry of Health. The total number of currently registered patients who are residents of Baghdad was 654. The prevalence of hemophilia increased from 7.2/100 000 males in 2007 to 15.9/100 000 males in 2016. Similarly, the incidence of hemophilia had increased from 8.4/100 000 ...

BACKGROUND The importance of developing public health surveillance system in mass gatherings has been emphasized in many 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 participated in the field data-collection over a period of 11 days during 12-22 November 2016. Data were collected from 20 health outlets along the major route from Najaf to Karbala (10 health facilities in each governorate). Two digitalized forms (Health Facility Survey and Case Survey) were used for data collection. RESULTS A total of 41,689 patients (33.3% males and 66.7% males) had attended the 20 health facilities over a period of 11 days between 12 Nov. 2016 and 22 Nov. 2016. More than three quarters of patients (77.5%) aged between 20 and 59 years. More than half of patients was mainly from Iraq (56.5%) and 38.9% were from Iran. Patients had attended the health ...

BACKGROUND Immunization averts >2.5 million child deaths annually. WHO and UNICEF estimates of immunization coverage in Iraq in 2015 revealed 58% for DTP3 and 57% for measles. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. OBJECTIVE To assess the impact of training of primary healthcare centers’ (PHCs) vaccinators on the quality of immunization session practices (ISPs). METHODS This was an interventional study conducted on ten (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were first 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's equipment, registration, communication, vaccine preparation and administration and waste management. The vaccinators were enrolled in a one-day training session using WHO module...

BACKGROUND During mass gatherings (MGs) public health services and other medical services planned to protect MG attendees as well as people living around the venue and minimize risk of disease spread. These services are essential components of adequate planning for MGs. The Arbaeenia MG signifies the remembrance of the death of Imam Hussain, celebrated by Shiite Muslims and it takes place in Karbala, which is a city in southern Iraq. This annual MG is attended by millions of people from within and outside Iraq. OBJECTIVE To map availability of medical supplies, equipment, and instruments and the health workforce at the temporary clinics installed in Baghdad Al-Karkh, Iraq, 2014. METHODS This assessment was conducted on the temporary clinics that served the masses walking to Karbala from Baghdad. These clinics were set up by governmental and non-governmental agencies and some faith-based civil society organizations, locally known as mawakib. We developed a checklist to collect information on clinic location, affiliation, availability of safe water and electricity, health personnel, availability of basic medical equipment and instruments, drugs and other supplies and average daily number of patients seen by the clinic. RESULTS A total of 30 temporary clinics were assessed, 18 clinics were set up by the Iraq Ministry of Health (MOH) and 12 by other governmental and nongovernmental organizations. The clinics were staffed by a total of 44 health care workers. The health workers served 16,205 persons per day, an average of 540 persons per clinic, and 368 persons per health care worker per day. The majority of clinics, 63%-100% had basic medical diagnostic equipment. Almost all clinics had symptom relief medications (87%-100%). Drugs for diabetes and hypertension were available in less than 55% of the clinics. The majority of clinics had personal hygiene supplies and environmental sanitation detergents (78%-90%), and around 50% had medical waste disposal supplies. Instruments for cleansing and dressing wounds and injuries were available in almost all clinics (97%), but only four clinics had surgical sterilization instruments. CONCLUSIONS While temporary clinics were relatively equipped with basic medical supplies, equipment and instruments for personal medical services, the health workforce was insufficient given the number of individuals seeking care, and only limited public health service, personal infection control, supplies were available at the clinics.

Background: The surface web is a rich source of extensive data on populations of users and misusers of psychoactive substances including substances known as hallucinogens and entheogens. The internet and its social media websites can serve as a database upon which several hypotheses are applicable via thematic analytic and psychoanalytic studies. Materials and Methods: This study will deploy the use of an internet snapshot by inspecting, via thematic analysis, the comments of a population of psychedelic (ab)users existing on the Facebook social platform. The snapshot will dare to answer an existing question in connection with the concept of using psychedelics and entheogens during the moments preceding death. Several demographics will be explored including ethnic-national and socio-cultural parameters to test several hypotheses about the tendencies for having an ultimate pre-mortem psychedelic trip towards the ambiguous afterlife. Results: Most of the psychedelic users recommended t...