Tobacco survey

Almost a third of health professionals recognise the dangers of smoking yet have still smoked themselves, according to the second stage of an important survey by the World Health Organisation (WHO). However, all are agreed on the need for greater access to cessation interventions and comprehensive tobacco control.

The study – developed by WHO in collaboration with the Centres for Disease Control and Prevention (USA), International Agency for Research on Cancer, Emory University (USA) and University of New South Wales (Australia) – aimed to assess smoking among health professionals and the impact on their ability to help others quit the habit.

The study surveyed 11,000 health professionals in five countries of the WHO Eastern Mediterranean Region (Egypt, Jordan, Libyan Arab Jamahiriya, Qatar and Saudi Arabia). The first round was administered in WHO member states Oman, Bahrain, Iran, Sudan and Kuwait.

That smoking is harmful to health was agreed by 97.9% of survey participants; however 33% reported being current or former smokers. Sixty seven per cent said they had never smoked while 10% reported having successfully quit smoking and 23% were current smokers. Of the respondents, 7,613 (70%) were physicians, 701 (6%) were dentists, 1,394 (13%) were nurses and 1,226 (11%) worked in supporting professions.

The sample consisted of 66% males and 34% females. The average age of respondents was 39 years. The proportion of smokers was 32% among male respondents and 5% among female respondents. The survey showed that smoking affects the image of health professionals as role models for their patients. Eighty three per cent of non-smoking health professionals and 70% of smoking colleagues said they believed a physician who smokes is less likely to advise his/her patients to stop smoking.

Health professionals responding to the survey overwhelmingly supported banning smoking in enclosed public places, using large-print health warnings on cigarette packaging, banning sales to minors, banning sport sponsorship by the tobacco industry, banning tobacco advertising completely and making hospitals completely smoke-free. Price increases caused some disagreement with 84% of non-smokers and just 66% of smokers supporting sharp increases as a measure to assist smokers in quitting and to prevent young people from starting to smoke.

Despite 72% of respondents reporting lack of availability of interventions (other than counselling) for patients who smoke, physicians can offer a range of effective smoking cessation interventions to their patients. Expanding access to medication and self-help, coupled with improved smoking cessation counselling training for physicians would expand coverage of effective smoking cessation interventions in the countries surveyed.

DOHMS directory

Dubai Department of Health and Medical Services (DOHMS) will produce the first directory of medical services in the emirate. It is due for release next year. The first directory will provide a comprehensive overview of medical service providers in Dubai.

AbdulRahman Belsalah, director, Specifications & Licensing Dept, said: “This directory is intended not only for those seeking medical aid, but also for those supporting the medical infrastructure in Dubai and the UAE. The directory will provide access to around 5,000 DOHMS-registered medical service providers, including 1,200 public and private clinics and hospitals. In the alphabetical and classified sections, the directory will list practitioners, doctors, polyclinics, speciality clinics, pharmacies, hospitals, laboratories, medical equipment suppliers, medical service providers and companies engaged in work for the medical sector.

A profile section will feature full-page descriptions of medical companies, specific medicines and medical practitioners. The hardbound volume will also include maps to highlight locations of prominent medical institutions. DOHMS directory will be distributed across the GCC. The directory will also be produced as a CD-ROM and will be available online next year.

Online CME portal

Online CME portal More than 800 doctors from Qatar, Kuwait, Oman, Saudi Arabia and the UAE have registered for the International Institute of Research’s (IIR) online Continuing Medical Education (CME) programme, now a year old.

Over 400 doctors have also subscribed to IIR’s online CME courses. The IIRCME programme is accredited by the American Academy of Continuing Medical Education (AACME. “IIRCME is one of the few AACME worldwide online accreditation providers,” said Dr Bill Moore, co-chair of the committee for review & recognition (CRR).

“There is mounting pressure in the UAE for all medical professionals to complete a minimum number of CME credits per year to keep up with advances in treatment methods,” explained Dr Wael Al Mahmeed, consultant cardiologist at Al Jazeera Hospital and chair of the CME programme at Abu Dhabi General Authority for Health Services. “Doctors are beginning to understand the importance of acquiring credits, not only for professional enhancement but ultimately for better standards of patient care.”


New dialysis unit

Belhoul Specialty Hospital in Dubai, UAE, has opened a new nephrology department that includes four state-of-the-art dialysis machines. Dr Paulose Thomas a nephrologist at the hospital explained that a small unit was started in 2003, but high demand led the hospital to expand the unit.

Two of the dialysis machines are housed in one room and are used by visitors requiring regular kidney dialysis treatment. A third, Fresnias multi-filtrate machine, is housed in a separate room and can be used to clear the blood of toxins such as alcohol and barbiturates, as well as performing kidney dialysis.

It can also be used for plasma exchange and dialysis in the Intensive Care Unit. A fourth haemodialysis machine, a Gambro, is isolated and used exclusively for treating patients who have blood infections such as hepatitis.

To prevent the spread of infection, the water used for dialysis in the Gambro is put through an on-site, four point purification process including ion filtration, carbon filtration, water softeners and reverse osmosis to ensure purity. Dr Thomas pointed out that government hospitals had long waiting lists at their dialysis units and visitors to Dubai who required regular dialysis treatment could make use of these facilities.

Syria AIDS awareness

In Syria a national campaign has begun to develop greater awareness of AIDS among NGOs, social workers and staff at Syria’s National AIDS Programme, reports IRIN News.

“A recent workshop focused on education on sexually transmitted diseases and how to look at Communicating Behaviour Change to prevent young people in Syria from becoming infected with AIDS,” Dr Imad al-Daker, national officer for HIV/AIDS at the United Nations Children’s Fund (UNICEF) office in the capital, Damascus, said. Najah al-Najjar, a social worker who provides counselling at a women’s prison in Damascus, said: “The course has provided me with good information that enables me to raise awareness among prisoners to protect themselves from AIDS infection and give them hope, especially those who are imprisoned in a special high risk facility that includes about 60 commercial sex workers and drug addicts.”

Communities must be prepared to accept HIV/AIDS testing and HIV-related services and assistance being offered by counselling and referral centres, especially for women and young people, she added. Dr Maysaa Mardiny, National AIDS Programme head, said in Damascus: “The number of HIV/AIDS cases reported in the first quarter of this year, 2005, is 341, of which 134 are foreigners and 207 Syrians. Non-Syrians testing positive have been deported to their own countries.”

The NGOs recently came together in an effort to coordinate preventive work for different high-risk groups, under an initiative of the Syrian Family Planning Association, in co-operation with UNICEF. Volunteers from NGOs usually visit locations such as prisons and night clubs to raise awareness of HIV/AIDS, in addition to communicating with young people who visit AIDS counselling centres.

“Societal behaviour change is essential, especially regarding marketing of condoms and other HIVrelated services and supplies, as well as approaching the epidemic seriously at all levels, starting from the national level and down to the local community,” Dr Gary Gleason, an expert in communication skills, said.

Iraqis sell their blood

IRIN News reports that due to a shortage and high demand Iraqis are selling their blood to people who are buying supplies for relatives in need, according to doctors.

This has caused concern over the spread of disease since the supplies are not checked for bloodborne infections.

Every day hundreds of donors can be seen standing outside the blood bank at the Iraqi National Centre for Blood Donations (INCBD) in the capital, Baghdad. More people have started to donate blood following shortages and a call from the Health Ministry for increased supplies to cope with the high level of bloodshed in the country and the need for urgent blood transfusions.

However, people in the queue willing to donate for free are being intercepted before they reach the centre. Donors are approached by so called ‘negotiators’ who pay them between US$15 and $20 per blood bag. At a time when unemployment stands at 33% and most of the country is still dependent on food rations, the sale of blood may be an attractive option for many. "Every week I come here to sell my blood.

It is very easy to get someone to buy it because many families are desperate to help their loved ones who are injured in the hospitals," Nazaare Ammar from Baghdad said, as he stood in the queue to donate blood. "I was searching for a job for a long time but they pay very little or they ask for typing or English skills and I don't have this so selling blood is easier,” he added.

The procedure entails the buyer, someone who is usually in need of supplies for a loved one in hospital, presenting the negotiator with the blood type needed along with the quantity required. Then the negotiator approaches donors in the queue who have the same blood type and enters the donation room with them.

There they negotiate with the blood collectors and persuade them to release the bag stating that there is an emergency. Within half an hour the bag is taken to the buyer, containing approximately 350 cubic centimetres of blood. Health officials say there is little they can do about the sale but have stepped up measures at the collection point. Dr Haydar Shamari, director of the INCBD said that many blood samples were found to be carrying hepatitis C virus, but that luckily no HIV cases have yet been detected.

"The high requirement of blood every day has resulted in desperation from families to buy blood directly from donors. In our latter analyses we have found cases of infections which have definitely been transmitted to the patient through transfusion," he explained.

Dental care campaign

Alarming results from a UAE Ministry of Health (MoH) study of dental care in the country, has prompted the MoH to initiate the UAE National Oral Care Preventative Programme with the assistance of toothbrush manufacturer, Oral-B.

The MoH’s national survey of five, 12 and 15- year-olds showed a very low percentage of children were cavity free. In Abu Dhabi, for example, less than 20% of children surveyed had no cavities.

The results prompted the MoH to develop a strategy to improve dental care among children, Dr May Nadeef, consultant for Dental Department, MoH, told Middle East Health. “Tooth cavities and gum disease are easily preventable with the correct oral hygiene habits.

Treating dental disease is expensive, so it is in the MoH’s interest to implement a preventative care programme,” Dr Nadeef said. She added that with the help of Oral-B, the MoH will implement a threephase programme.

The first phase will target mothers with children under three, the second phase will target four to fiveyear- olds, while six to 13- year-olds will be targeted in the third phase. Ranu Kawatra, regional business director for Oral-B Middle East and Africa, said: “Oral-B will take the campaign to schools where we will introduce oral care in a fun way, as well as give out toothbrushes and educational material. Our focus will be on the children and their parents as well as nurses.

We will teach them how to brush properly, that you need to brush twice a day and other important preventative measures.”

Traffic accidents

Road traffic accidents kill 1.2 million people every year and injure or disable as many as 50 million more. They are the second leading cause of death globally among young people aged 5 to 29 years and the third leading cause of death among people aged 30 to 44 years.

They cost low-income and middle-income countries more than the total development aid they receive. Without immediate action to improve road safety, it is estimated that road traffic deaths will increase by 80% in low- and middle-income countries by 2020.

Across the WHO Eastern Mediterranean Region, which includes most Arab countries, more than 130,000 people die on the roads every year, and road traffic injuries are the eighth leading cause of death for people of all ages. The vast majority of these deaths occur in the region's lowand middle-income countries.

Unlike high-income countries, where those most at risk of injury or death are drivers and passengers in cars, equally at risk of being involved in a road traffic crash in low- income and middle-income countries are pedestrians, cyclists and users of informal modes of public transport.

The Arabic version of the World Report on Road Traffic Injury Prevention was launched on 12 July, in Amman, Jordan, at a regional event held under the patronage of Her Majesty Queen Rania Al- Abdullah, who recently consented to becoming WHO Patron for Violence Prevention in the Eastern Mediterranean Region. The World Report on Road Traffic Injury Prevention reflects the magnitude of this growing global public health crisis.

The risk factors that lead to road traffic deaths and injuries and effective ways to prevent them are detailed in the report. Published by the World Health Organisation and the World Bank, the report provides governments and other policymakers, industry, nongovernmental organisations, international agencies and individuals with concrete recommendations to improve road safety. “Much can be done to reduce the toll of deaths and injuries on the world's roads” Dr Hussein Gezairy, WHO Regional Director for the Eastern Mediterranean Region, said. He added: “More than 3,000 people die from road traffic accidents each day, but these are not random events or ‘accidents’.

Rather they are incidents whose risks may be examined, understood and predicted. We have the knowledge to act now to prevent road traffic accidents. Road safety is no accident. It is a question of political will." Demonstrating her commitment to the cause, Queen Rania launched Jordan's National Traffic Awareness Campaign in April and is now leading national efforts to develop a comprehensive strategy for the prevention of road traffic accidents in Jordan.

"Public health has a vital role to play in working with Member States to highlight the grave concern posed by road traffic injuries, by ensuring availability of reliable information on the magnitude, causes and consequences as well as assisting in the developing of effective strategies for prevention", said Dr Ala' Din Alwan, WHO Representative in Jordan.

Among the recommendations of the World Report on Road Traffic Injury Prevention are the appointment of a lead agency in every country to co-ordinate multi-sectoral efforts, the preparation of national road safety strategies and plans of action with clear roles and objectives for each sector, and the implementation of proven interventions to prevent crashes and minimise injuries and their consequences.

Saudi polio directive

The Ministry of Health of Saudi Arabia has announced that all people under the age of 15 years travelling to Saudi Arabia from countries reporting wild poliovirus must be immunised against polio in order to gain access to the country.

The new directive stipulates that people under the age of 15 years travelling from the following countries will be required to show valid and up-to-date proof of vaccination to obtain visas for entry to Saudi Arabia: Afghanistan, Angola, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Egypt, Eritrea, Ethiopia, Guinea, India, Indonesia, Mali, Niger, Nigeria, Pakistan, Sudan and Yemen.

In addition, irrespective of previous immunisation status, polio vaccinations for people under the age of 15 years arriving from the above-mentioned countries for any purpose including the Hajj or Umrah will be mandatory at Saudi Arabian border points. The directive has been issued in response to the continuing international spread of poliovirus.

Meanwhile in Yemen the latest update on the polio epidemic in the country from the World Health Organisation is as follows:

• As of 10 August a total of 775 Acute Flaccid Paralysis (AFP) cases were reported.

• The number of laboratory confirmed cases was 412 distributed all over 21 of the 22 provinces.

• The number of reported AFP and confirmed cases continue to decrease particularly after the first round of vaccination with monovalent oral polio vaccine type 1 (mOPV1).

• Eight provinces have had no cases since mid June.

• The impact of the second mOPV1 round is not evident yet.

• Most of the positive cases which have appeared after 10 days from the beginning of the first mOPV1 round are from Hajjah and Saadah provinces. These recent cases are being subjected to special epidemiologic investigation.

Yemen has reported cases of polio with date of onset starting February 2005. Most of the cases are from Hudeida governorate on the Red Sea coast. Prior to these cases, wild poliovirus has never been found in Yemen since AFP surveillance Polio virus commenced in 1996.


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