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Municipalities in Lebanon represent local governments at the basic community level. The proximity of the municipality to the local community and its knowledge of available resources, can be crucial in easing the impact of any disaster. This study aimed to document the range of preparedness/reactivity of municipalities as COVID-19 swept through Lebanon. A qualitative case study was implemented to explore municipal response to control the epidemic, using in-depth semi-structured interviews with twenty-seven stakeholders from nine municipalities across all governorates in Lebanon. In each municipality, participants included mayors/deputy mayors, available members of municipal councils, prominent community leaders, health care professionals, and managers of local NGOs. The collected data were analyzed using the comparative thematic analysis. The socioecological model was adopted to illustrate the dynamic interplay between the barriers and facilitators at all ecological levels. The response to the pandemic differed significantly in volume and nature among different municipalities across regions, with rural areas clearly disadvantaged in terms of adequacy and completeness of response. Barriers consistently mentioned by most municipalities included economic collapse and poverty, shortage in resources, lack of support from the central government, stigma, lack of awareness, underreporting, flaws in the MOPH surveillance system, impeded accessibility to healthcare services, limited number and weak role of municipal police, increased mental illnesses, and political patronage, favoritism, and interference. On the other hand, increased donations, community engagement, social support and empathy, sufficient human resources, the effective role of healthcare systems, and good governance were identified as key facilitators. The socioecological model identified several multi-level facilitators and loopholes which can be addressed through a suggested strategic "roadmap" providing evidence-based interventions for future epidemics. It is crucial meanwhile that the central government strengthens the administrative and financial resources of municipalities in preparing and rapidly deploying the expected optimal response. [ABSTRACT FROM AUTHOR]

Waterpipe tobacco smoking (WTS) has become a serious public health threat in the Middle East and beyond. To estimate the prevalence rates of cigarette and WTS among Lebanese women and describe characteristics associated with each behavior. Secondary analysis of women's health data obtained in a national survey in 2010. Of 2,255 selected women, 78 percent reported no or past long-term WTS. Among the 12 percent of regular waterpipe smokers, 40 percent were light users (mean three waterpipe heads weekly), while 60 percent were heavy users (mean of 11 heads per week). About 70 percent were never or past long-term cigarette smokers. Younger age, location within Greater Beirut (GB) and having professional employment were significantly associated with use of WTS. Older age, GB location, lower education, and ever-married were significantly associated with cigarette smoking. WTS is becoming a socially normative behavior among empowered professional women, who can spare the time and expense to engage in this behavior in easily accessible cafés, which prohibit cigarette smoking. Government, media, and NGO campaigns against smoking should target waterpipe use, not only in Lebanon but also across the Arab world and among Arab communities in the Diaspora with messages different from anti-cigarette campaigns. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate trends in the increasing costs of oncology drugs procured by the Lebanese Ministry of Public Health (MOPH) between 2014 and 2016 and to assess the impact of the introduction in mid-2015 of new immunotherapy drugs for the treatment of lung cancer on the overall and specific costs of that treatment. Methods: A secondary analysis of data from the MOPH Cancer Drug Scientific Committee data base was conducted using a total of 18,133 cancer files between 2014 and 2016. Results: Over the 3-year period, about $140 million (USD) was spent on cancer drugs by the MOPH free cancer drug dispensing program. The expenditures increased by 27% after immunotherapy was phased in. The average cost of drugs per patient per year measured across all cancer types increased from $7,000 in 2014 to $8,400 in 2016. Trastuzumab, approved for treating human epidermal growth factor receptor 2-positive breast cancer ranked first in total expenditures for 2014-2015. By 2016, two new immunotherapy drugs had topped the list: pembrolizumab ranked first and nivolumab ranked third, representing 64% of the total cost of lung cancer treatment and approximately 19% of the total yearly budget; beneficiaries represented only 3% of all patients. Conclusion: This update documents the increasing financial impact of newer cancer drugs on the procurement process in the middle-income country of Lebanon. The trend is aligned with the financial burden of cancer drugs worldwide, which calls for a collaborative global response to this crisis. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate trends in the increasing costs of oncology drugs procured by the Lebanese Ministry of Public Health (MOPH) between 2014 and 2016 and to assess the impact of the introduction in mid-2015 of new immunotherapy drugs for the treatment of lung cancer on the overall and specific costs of that treatment. Methods: A secondary analysis of data from the MOPH Cancer Drug Scientific Committee data base was conducted using a total of 18,133 cancer files between 2014 and 2016. Results: Over the 3-year period, about $140 million (USD) was spent on cancer drugs by the MOPH free cancer drug dispensing program. The expenditures increased by 27% after immunotherapy was phased in. The average cost of drugs per patient per year measured across all cancer types increased from $7,000 in 2014 to $8,400 in 2016. Trastuzumab, approved for treating human epidermal growth factor receptor 2–positive breast cancer ranked first in total expenditures for 2014-2015. By 2016, two new immunotherapy drugs had topped the list: pembrolizumab ranked first and nivolumab ranked third, representing 64% of the total cost of lung cancer treatment and approximately 19% of the total yearly budget; beneficiaries represented only 3% of all patients. Conclusion: This update documents the increasing financial impact of newer cancer drugs on the procurement process in the middle-income country of Lebanon. The trend is aligned with the financial burden of cancer drugs worldwide, which calls for a collaborative global response to this crisis. [ABSTRACT FROM AUTHOR]

Background: The implications of rapid aging of the Lebanese population are under-researched. No national studies have so far investigated the living conditions and the health status of urban Lebanese elderly across gender. Methods: This was a cross-sectional study involving 905 randomly selected community dwelling elderly aged ≥65 years living in Greater Beirut. Gender differences were assessed among participants who completed a standardized questionnaire on socio-demographic factors, nutritional, health, and functional characteristics. Results: The sample included 533 men (59%) and 372 women (41%). Elderly were regrouped into 'younger elderly' (≤70 years), and 'older elderly' (>70 years) which represented respectively 44.3% and 55.7% of the total population. Women, regardless of their age, were less educated and more likely to live alone. Moreover, poor nutritional status, self-perceived health, absence of physical activity, comorbidity, polymedication and depression were significantly higher among women. 'Older elderly' women became significantly more functionally disabled compared with men of their age. Conclusions: This study evidenced that Lebanese elderly women were disadvantaged regarding their socio-economic, health and functional status. It is requested a nationwide effort to improve the socio-economic status and the health of Lebanese elderly, especially women. [ABSTRACT FROM AUTHOR]

Aim To assess the nutritional status, and its association with sociodemographic factors, health and functional status of community-dwelling older adults living in the Greater Beirut area. Methods This was a cross-sectional study involving 905 randomly selected community dwelling older adults aged ≥65 years living in Greater Beirut ( Beirut and surrounding suburbs). Participants completed a standardized questionnaire on sociodemographic factors, health characteristics, and functional and nutritional status, based on the Mini Nutritional Assessment. Results Among the older adults who participated in the study, 2.8% (95% CI 0.01-0.03) were malnourished, and 45.5% (95% CI 0.42-0.48) were at risk of malnutrition. Sociodemographic variables were not associated with the nutritional status. Variables significantly associated with poorer nutritional status were: poor perception of general health ( OR 1.58, 95% CI 1.28-1.97), more chronic diseases ( OR 2.05, 95% CI1.26-3.33), poor perception of oral health ( OR 1.36, 95% CI 1.14-1.61), depressive disorders ( OR 1.76, 95% CI 1.30-2.40), higher body mass index ( OR 1.98, 95% CI1.67-2.34) and disability ( OR 5.80, 95% CI 1.96-17.11). Conclusions The present study showed an unacceptable risk of malnutrition among Lebanese older adults, independent of age, sex and socioeconomic status. The presence of comorbidities, treated or not, affecting general and oral health emerged as major determinants of poor nutrition. Geriatr Gerontol Int 2017; 17: 424-432. [ABSTRACT FROM AUTHOR]

Abstract: Background: Current data from the Middle East suggest a rapid increase in the incidence of smoking water-pipes (narguileh in Lebanon) in parallel with cigarettes. The social context in which these two behaviors are initiated and associated has not been studied. Methods: Data from a standardized questionnaire to measure the prevalence and practices related to cigarettes and narguileh consumption in a representative sample of 1097 children in grade 9 were extracted and analyzed for elements of the social context in which consumption occurs. Results and discussion: Among surveyed children (mean age 14.6), 3.9% were “frequent” cigarette smokers (more than nine times ever). Presence of parents and/or siblings who smoke is a key factor for initiation. Narguileh use is a social phenomenon, rarely smoked alone (<4%) with 19% of the surveyed children being “frequent” narguileh smokers (more than nine times ever). Almost half of these students (42%) have all their friends smoking narguileh. Conclusions: Further analysis confirmed that narguileh use is now an accepted familial and social phenomenon, with restrictions apparently decreasing. These results necessitate drawing strategies to address this public health concern that is becoming more prevalent in Lebanon and elsewhere in the Middle East. [Copyright &y& Elsevier]

Background: A review of the literature clearly indicates the absence of one set of guideline in the treatment of recurrent vulvovaginal candidiasis. In Lebanon, as physicians are trained in European or American schools of medicine, locally or abroad, they may be approaching the issue of recurrent vulvovaginal candidiasis using various methods. Aims: A national survey was conducted among Lebanese gynecologists to assess therapeutic protocols most commonly adopted to treat recurrent vulvovaginal candidiasis. Background: A review of the literature clearly indicates the absence of one set of guideline in the treatment of recurrent vulvovaginal candidiasis. In Lebanon, as physicians are trained in European or American schools of medicine, locally or abroad, they may be approaching the issue of recurrent vulvovaginal candidiasis using various methods. Aims: A national survey was conducted among Lebanese gynecologists to assess therapeutic protocols most commonly adopted to treat recurrent vulvovaginal candidiasis. Results: The study confirms that different approaches are used to treat recurrent vulvovaginal candidiasis. Most gynecologists (70%) recommended fluconazole 150 mg as first-line treatment. Fluconazole alone was significantly preferred by North American trained physicians, whereas European trained ones preferred to prescribe it in combination. However different dosage regimens were used with duration of treatment ranging from 2 to 4 weeks, with or without maintenance. Conclusions: The study revealed large diversity in prescription pattern, closely related to the specialization background of the physician. There is a need to generate evidence to establish national guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Background: Review and analyses of the 2004 Lebanese National Breast Cancer Registry (the most recently available complete national data). Methods: Crude, age-standardized rates (ASRs), and age-specific rates per 100,000 population were calculated and results were compared with estimates from Western, regional, and Arab countries. Results: Breast cancer constituted about 38.2% of all cancer cases among Lebanese females in the year 2004. The median age at diagnosis was 52.5 years. The age-standardized incidence rate per 100,000 was estimated at 71.0. ASRs remained lower than those observed in developed countries and in the Israeli Jewish population; however, they were greater than those estimated for Arab populations in the region. Five-year age-specific rates among Lebanese women were among the highest observed worldwide for the age groups 35–39, 40–44 and 45–49 years, with the exception of Israeli Jews for the age groups 35–39. Conclusions: Results endorse the new guidelines developed by the Lebanese Ministry of Public Health to start breast cancer screening with mammography at 40 years of age. Further efforts are needed from different stakeholders in order to realize a comprehensive and full database, and to enhance awareness for early detection at all age groups. [Copyright &y& Elsevier]

Background: A significant number of Lebanese medical graduates have emigrated from Lebanon. The objective of this study was to evaluate the hypothesis that the repatriation of Lebanese physicians educated abroad has contributed to the international emigration of recent Lebanese medical graduates. Methods: We analyzed the demographic and educational characteristics and the year of registration of physicians registered with the two physician associations in Lebanon as of 2007. We then analyzed the number of new and total registrants and the physician density for the years 1977-2006. Finally we calculated the percentage of Lebanese graduates of the years 1977-2006 registered as of 2007. Results: As of 2007, 10,918 physicians were registered in Lebanon. Most were male (80.4%) and graduated from either Lebanese (36.4%) or Eastern European (30.6%) medical schools. The top three regions of specialty training were Western Europe (31.8%), Eastern Europe (28.4%) and Lebanon (25.7%). About half the physicians registered with the Lebanese Order of Physicians as of 2007 joined during the 1990s decade; only 26.2% of these graduated from Lebanese medical schools during that decade. The number of new registrants increased dramatically in the early 1990s and started decreasing in the early 2000s. About 60% of Lebanese medical graduates of the years 1977-2006 were registered in Lebanon as of 2007. Categorizing Lebanese medical graduates by their year of graduation, the percentage registered in Lebanon as of 2007 showed a "dip" for those who graduated in the early 1990s. Conclusion: The high number of physicians educated abroad returning to Lebanon after the end of the civil war may have driven recent Lebanese medical graduates to emigrate. [ABSTRACT FROM AUTHOR]

Objectives: to assess the attitudes of judges in Beirut, Lebanon, regarding end-of-life issues such as assisted suicide and withholding or withdrawing life-sustaining treatment.Subjects and Methods: 85% of all currently acting and in-training judges and public prosecutors in Beirut (N=135) were surveyed using a mailed questionnaire that assessed attitudes toward intervention in five hypothetical cases. The associations of attitudes, on a scale from least to most 'sympathetic' toward assisting those who desire to end their lives, were measured by a variety of personal, social and professional variables.Results: younger individuals, and those who have not yet been formally appointed as judges, were significantly more sympathetic to withdrawal or withholding of life-sustaining devices when patients or their proxies requested it, and more in support of assisted suicide. Gender, religious denomination, religious practice, and personal experience with prolonged illness leading to death among close friends or family, were generally not significant predictors of respondents' attitudes. Years of experience as a judge correlated strongly with age and may have contributed to its predictive effect.Discussion and Conclusions: a relatively more sympathetic attitude among younger judges, many of them women, and among trainees, may reflect a historical evolution in younger age-groups in Lebanon today. A survey of opinions in the public may help reach a more conclusive understanding in this regard. In any case, judges in Lebanon will remain important partners in the debate, as they will continue to be the final interpreters of the letter of the law in end-of-life issues. [ABSTRACT FROM AUTHOR]

Objectives--To measure the preference regarding disclosure of a serious diagnosis, and its determinants, of the Lebanese public. Design and setting--Non-random sample survey of 400 persons interviewed in health care facilities in Beirut in 1995. Results--Forty-two per cent of respondents generally preferred truth not to be disclosed directly to patients. Preference for disclosure was associated with younger age, better education and tendency to rapport-building with physicians. There were no meaningful associations between place of residence (urban/rural), level of religious practice, or religious affiliation, and preference for disclosure. Conclusions--Under one plausible interpretation, this survey suggests that the expectation for concealment will decrease as the advantage of knowledge in better coping with disease is understood by an increasingly better educated public, and that the Lebanese public will increasingly come to expect direct and full disclosure of serious diagnoses. [ABSTRACT FROM AUTHOR]

Presents a study which was conducted to determine the proportion of Lebanese physicians who choose truthful diagnosis disclosure to cancer patients. Factors which affected physicians decisions; Reference to a survey conducted; Details on the participants in the survey; Information on Lebanon's predicament regarding disclosure.

Presents several commentaries related to medical ethics. Changes in attitudes regarding cancer disclosure among medical students at the American University of Beirut in Lebanon; Discussion on Jehovah's Witnesses and blood transfusions; Participation of mentally ill patients in Israeli elections.

Objectives: This study aimed to assess the psychosocial determinants of intention to seek palliative care for the client themselves, or intention to enroll a family member in palliative care among the public in Lebanon. Methods: A cross-sectional study was initiated in 2020 on a convenience sample of adults permanently living in the Greater Beirut (GB) area; people with no current or previous experience with palliative care either for themselves or for someone dear to them were included. Verbal consent was obtained before data collection, and participants received a questionnaire to be self-completed, statistical analysis was performed using SPSS statistics version 23.0. Results: A total of 875 participants with a mean age of 42 years were interviewed, of whom 24 participants (2.7%) had had a previous experience with PC, either personally or with someone very close to them. The best-fit multivariate predictive model for intention to use PC included older age, positive attitude, and higher perceived control on one's health. The multivariate model for intention to recommend use was significantly associated with a positive attitude, higher perceived control, and lower perceived barriers. Conclusions: Promotional activities should be conducted to provide the Lebanese public with accurate, detailed, and direct information about the benefits of PC, involving essentially physicians. Future research should explore the decision-making process in "real-time" situations, and within our specific psychosocial, cultural, and organizational context.

Purpose: National cancer control strategies have been identified as essential tools for reducing and managing the growing burden of cancer in low- and middle-income countries. Cancer registration is an instrumental component of any cancer control strategy, providing the data to inform effective cancer policy. In the Middle East, North Africa, and Turkey (MENAT) region, cancer registration varies immensely and faces multifaceted challenges including protracted conflict. This study investigates and maps out the present capacities and outputs of cancer registration in the MENAT region and identifies thematic barriers facing implementation and utilization of cancer registry data., Materials and Methods: We used a self-administered online survey with open and close-ended questions targeting national and institutional cancer registry managers in the MENAT countries., Results: Registry managers from 19 MENAT countries reported the presence of 97 population-based, 48 hospital-based, and 24 pathology-based registries. Most population-based registries were well- or partially developed. Lack of accurate death records, complete medical records, and communication between stakeholders and deficiencies in trained personnel were critical challenges that were more severe in active conflict zones and neighboring conflict-affected regions. Cancer registration challenges included weak health infrastructure, absence of legislation mandating cancer registration, and disruption of cancer registration because of active conflict and loss of funding. Refugee host countries, such as Lebanon, Turkey, and Jordan, also reported conflict-related challenges including refugee mobility and lack of accurate data on forced migrants., Conclusion: This study provides a much-needed understanding of the current landscape and contextual challenges affecting cancer registration in the MENAT. These data are important for identifying areas on which to focus regional capacity-strengthening initiatives., Competing Interests: Ali ShamseddineConsulting or Advisory Role: BayerSpeakers' Bureau: Novartis, Sanofi, Merck, MSD, Amgen, Bayer, PfizerResearch Funding: Bristol Myers Squibb, Merck, Bristol Myers Squibb/MedarexTravel, Accommodations, Expenses: Amgen, MSD, Merck, Algorithm SAL Richard SullivanHonoraria: PfizerConsulting or Advisory Role: Pfizer Deborah MukherjiHonoraria: Novartis, Roche, Merck, Bristol Myers Squibb, Pfizer, Astellas Pharma, AstraZenecaConsulting or Advisory Role: MSD Oncology, Pfizer, Bristol Myers Squibb, Astellas PharmaResearch Funding: Bristol Myers Squibb, Merck Serono, NovartisTravel, Accommodations, Expenses: Amgen, Merck SeronoNo other potential conflicts of interest were reported.

Objective: By 2020, 70% of all cancers will occur in patients aged 65years and older, causing an increase in related morbidity, mortality, and cost. This study projects cancer trends in the elderly population in Lebanon, a country experiencing accelerating aging trends. Findings will guide future policy decisions regarding geriatric oncology in Lebanon and the surrounding Arab world., Materials and Methods: Cancer incidence rates were derived for men and women 65years and above, divided into three age groups: 65-69years, 70-74years, and 75years and above. Raw data were obtained from the National Cancer Registry reports 2003-2010. The eight consecutive year data were used to project the incidence until 2025 using a logarithmic model. The Average Annual Percent Change in incidence rates was calculated to determine whether it would significantly increase, decrease, or remain stable over time., Results: Incidence rates are projected to increase significantly in all age groups of both genders until 2025. In men, the fastest rise is expected in prostate cancer, followed by bladder, lung, colorectal, and NHL. In women, the rise will be fastest in breast, followed by colorectal, lung, NHL, and ovary. Projected rates increase faster in the "younger" age group 65-69 compared to the "oldest" ≥75, both in men and women. Only kidney and liver cancers continue to rise significantly after 75., Conclusions: Cancer incidence is projected to increase in individuals between 65 and 74years of age. Lebanese and Middle Eastern physicians must implement adapted therapeutic strategies in the management of the increasing caseload among frail, elderly patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To assess the priority of various aspects of the patient-primary care physician relationship in the decision to visit again that same physician. STUDY SETTINGS: A total of 400 community residents in Ras Beirut, Lebanon., Study Design: A cross-sectional community based study sampled by a nonrandom sex-education quota-based procedure., Data Collection: Participants were asked to fill a survey where they indicated the ranking of nine items by importance in their decision to revisit the same physician. The nine items were chosen from three categories of factors: professional expertise of the physician; characteristics of the patient-physician relationship, office organization., Results: Having a physician that gives the patient adequate time for discussion prevailed as rank 1 and luxurious clinic ranked as 9th. Affordability was one of the main concerns among men, those with poor health and those of lower socioeconomic status. Accessibility of the physician's phone was considered highly important among women and those of lesser education status., Conclusions: This study emphasizes the importance of adequate time with the patient, accessibility and affordability of the physician in maintaining continuity of care and patient satisfaction, beyond mere medical expertise.

Since the early 1990s, international recommendations have promoted folic acid supplementation during the periconception period as an effective way of preventing neural tube defects (NTDs). However, the adoption of this recommendation remains insufficient. To assess the awareness and actual intake of folic acid among married Lebanese women aged 18-45 years, a cross-sectional study was conducted among 600 women selected from all five administrative districts in Lebanon, using a multistage cluster sampling procedure. An anonymous questionnaire was completed which covered measures of knowledge and use of folate supplements, as well as demographic, socioeconomic and obstetrical factors. Sixty percent of surveyed women (60%; n = 360) had heard about folic acid. Doctors were the most frequent source of information (61.1%) but only 24.7% of women have been told of the correct period during which folic acid supplementation was useful. Overall, only 6.2% had taken folic acid tablets during the adequate period. Younger age, higher education level and stability/sufficiency of income appeared to be significant predictors of awareness among Lebanese women. Actual folic acid intake was significantly associated with younger age, higher number of pregnancies, planning the last pregnancy and having had that last one after 1990. In Lebanon, the level of folic acid awareness and adequate intake remain relatively low. Several approaches should be used to promote folic acid intake including awareness campaigns, and routine counseling by primary health care physicians on folic acid during preconception visits.

The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon (2006). Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year (2004). This official notification calls for breast self-examination (BSE) every month starting age 20, and a clinical breast examination (CBE) performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force (BCNTF) recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries.It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future.

Introduction: G6PD deficiency is one of the most prevalent genetic diseases in Lebanon (1% in Lebanese males). Easy and effective screening methods exist to detect this deficiency early in newborns., Objective: To assess the cost-effectiveness of G6PD deficiency screening in the routine work-up of every male newborn in Lebanon., Methods: Of 299 babies with G6PD deficiency detected between 1999 and 2004, 139 (46.5%) were located, contacted, and surveyed for their experience of acute anemia crises., Results: A previous community survey had indicated a 77.8% risk for an acute anemia crisis necessitating hospitalization in unscreened patients, most often associated with consuming fava beans raw or in combination products. In contrast, only 5 (3.8%) of the 139 screened G6PD-deficient babies had ever developed a severe acute anemia crisis. The risk for hospitalization following a crisis had thus been reduced by 95% among patients screened for G6PD deficiency, compared to those unscreened. The estimated mean cost of each hospitalization, which lasts on average 7 days, is 1450 USD. The cost of screening is about 3 USD. The analysis indicates that, given the current prevalence of the deficiency and the reduction in hospitalization rates associated with knowing one's status, the cost of systematic screening is about 2.58 times lower than that of anemia-related hospitalizations in an unscreened population., Conclusion: The efficiency of routinely testing evidenced here supports changes in screening policies for boys.

The incidence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Lebanon is estimated at 10 per 1,000 in men and 0.4 per 1,000 in women. A community-based cluster sampling survey was conducted in 15 villages in all areas in Lebanon. The survey found 36 cases of G6PD deficiency among 3,000 men aged 14 years and above, yielding a cumulative incidence rate of 12 per 1,000. Of those 36 cases, 28 (77.8%) knew of their problem since they had already suffered at least one severe anaemia crisis in their childhood following the ingestion of raw green fava beans. The remaining 22.2% were not aware at all of their defect. These findings confirm that G6PD is a common genetic problem in Lebanon. The efficiency of early screening programmes in terms of preventing severe, at times potentially lethal, haemolytic crises is currently being investigated.

Objectives: Measuring the prevalence and determinants of narghile smoking among teenagers in schools in the southern suburbs (Dahia) of Beirut, Lebanon., Methods: A simplified questionnaire was self-completed by intermediate and secondary students selected from private and public schools in Dahia the year 2001-2002. Variables obtained included details on narghile and cigarette smoking, socio-demographic characteristics of the student and his/her family, friendship networks, and beliefs regarding health., Results: A total of 1461 students completed the questionnaire, of which 24% admitted regularly (> once/week) smoking the narghile and 14.4% occasionally, with a male predominance. The initiation was at about 13.6 yrs of age, but it varied from as low as 5 to 18 yrs. At least 28% of first narghile trial took place with a member of the immediate family, even though 58.2% initiated with a user friend. The monthly cost of using narghile did not exceed 7 USD for about half of narghile users in that area., Conclusions: Narghile use is a behavior gaining in importance in Lebanon in general, and in the Dahia area in particular. Its initiation among adolescents means that the probability of addiction is higher and the adverse health consequences are potentially more severe. It requires immediate interventional procedures including the launching of a campaign of national awareness for which hard data, such as those provided by this study, will be needed.