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Background: Polypharmacy and potentially inappropriate prescribing (PIP) are global issues that are associated with morbidity and mortality, especially in the elderly. Polypharmacy and PIP are highly prevalent in patients with cardiovascular diseases (CVDs). However, there is no data about the magnitude of the problem among patients with CVDs in Middle East and North Africa (MENA) region. Objectives: To conduct a systematic review on the prevalence of polypharmacy in the MENA region. Methodology: Key databases including PubMed, EMBASE, and Cochrane library were systematically searched for studies reporting the prevalence of polypharmacy among the elderly in the MENA region. Two reviewers assessed the eligibility and the quality of the studies independently. Thereafter data were extracted and synthesized using a narrative approach. Results: The prevalence of polypharmacy ranged from 17.2% to 88.6% among the elderly in the MENA region. Conclusion:This paper shows that polypharmacy and PIP are MENA region, emphasizing major issues in the the need for further research on the feasibility of interventions that minimize PIP , especially among elderly patients with CVDs and an increasing number of medications. policies that target the Future research may investigate methods and doctors and the pharmacist to increase their familiarity with the use of evidence-based tools for the identification and minimization of PIP.

Introduction: Breastfeeding is the clinical gold standard for an infant's nourishment. Worldwide, less than one in two newly born infants are breastfed within the first hour of birth and only 44% of infants are exclusively breastfed. Despite the importance of breastfeeding, rates in the Middle East and North African (MENA) region are still not within the 2030 World Health Organization targets to reach 70% for early initiation of breastfeeding within the first hour (EIBF), 70% for exclusive breastfeeding under 6 months (EBF), and 80% for continued breastfeeding at one year (CBF). Aim: This study aims to estimate the overall prevalence of EIBF, EBF, and CBF for the MENA region by income level, delivery mode (cesarean section), baby-friendly hospital initiative (BFHI), survey period, and ethnicity. Methods: A meta-analysis was conducted using national estimates from the Multiple Indicator Cluster Survey and the Demographic Health Survey. Overall pooled prevalence estimates of EIBF, EBF, and CBF were calculated using a random-effects model. Forest plots were used to display results from individual studies and pooled analyses. Cochrane Q statistic (chi-square test) and I-squared statistics were used to assess heterogeneity among surveys. Subgroup analysis and meta-regression were conducted to investigate the effects of income levels, cesarean section, BFHI, survey period, and ethnicity on the prevalence of the breastfeeding indicators. Sensitivity analysis was performed to examine the effect of outliers. Results: A total of 12 national surveys were included in this meta-analysis. The overall pooled prevalence of EIBF was 42% (95% CI: 33%, 52%), EBF 32% (95% CI: 24%, 41%), and CBF 63% (95% CI: 53%, 73 %). Breastfeeding practices decreased as income levels increased, except for EIBF. As cesarean section rates increased to more than 10%, the prevalence of breastfeeding indicators decreased. Availability of BFHI enhanced the high rates of breastfeeding practices. EIBF was higher among Arab mothers, however, EBF and CBF were higher among non-Arab mothers. Breastfeeding indicators were higher among countries with survey period 2012-2015 than countries where data were collected after 2015; this result was statistically significant only for the CBF indicator (Meta-regression ?= -0.264; p

Background: Qatar has one of the highest prevalence rates for diabetes in the world. Arteriosclerotic cardiovascular diseases (ASCVDs) are responsible for nearly 50% of deaths among patients with diabetes in Qatar. Treating with statins is a simple and effective approach for preventing ASCVD among patients with diabetes. Local and international guidelines recommend the use of statins for primary prevention of ASCVD in patients with diabetes, especially for those 40-75 years of age. Yet statins are still under-prescribed to diabetic individuals for primary prevention of ASCVD worldwide, especially in primary care settings which is where most of the medical management of diabetes occurs. Little is known about the prevalence of statin prescription for primary prevention of ASCVD among diabetics in primary care settings in Qatar. Objectives: To measure the proportion of T2dm patients receiving statins for primary prevention of ASCVD in primary care settings and to investigate patients' characteristics associated with statin prescription. Methods: A cross sectional review of electronic medical records of patients with T2dm 40-75 years of age, treated in any of the 27 health centers operated by Primary Healthcare Corporation, the largest primary care provider in the country, during calendar year 2019. A multivariable logistic regression model was used to estimate the odds of being prescribed statins and to adjust for confounding variables. Results: Of 23,934 patients with complete data, 57% were males and 31.9% were Qatari nationals. Average age for participants was 54.8 ± 8.25 years. 66 % of the patients received statins at least once during the year 2019. The statin prescription rate for Non-Qatari males was 70.1% and was significantly higher than non-Qatari females, Qatari females, or Qatari males (62.2%, 62.9% and 63.9% respectively P value

Background: Osteoporosis and its associated fragility fractures pose a significant public health issue in the elderly population. Additionally, diabetes has been linked to an increased risk of fragility fractures. In Qatar, little is known about the burden of fragility fractures and their association with osteoporosis or diabetes. Aims: Determining the burden of incident fragility fractures, following a bone mineral density (BMD) test, and the effects of having lower BMD levels and being diabetic on the risk of fragility fractures in the population aged fifty and older. Additionally, assessing the impact of database selection for the BMD reference range used to establish osteoporosis diagnosis on fracture risk estimates in the Qatari women subpopulation. Methods: In this retrospective hospital-based cohort study, patients who underwent BMD testing between May 2016 and June 2019 were followed through their health records from the date of the first test until the first fracture or their last encounter (before April 2020), whichever came first. The incidence rate of fractures per 1000 personmonths of follow-up was estimated. Univariate and multivariate Cox proportional hazards regression analyses were performed to determine the effect of BMD and the effect of diabetes on fracture-free survival. Fracture rates among patients with osteoporosis and sensitivity for detecting incident fractures were estimated and compared using the National Health and Nutrition Examination Survey (NHANES) and the Qatari databases. Results: The cohort consisted of 705 patients who had a median follow-up time of 31.03 months (IQR=12.05). The incidence rate was 1.73 (95% CI= (1.23-2.42)). The crude hazard ratio (HR) for fragility fracture per standard deviation reduction in BMD was 1.82 (95% CI= (1.34-2.48)) and 1.93 (95% CI= (1.37-2.71)) when adjusted for age and gender. Compared to not being diabetic, HR for being diabetic was 1.36 (95% CI= (0.69-2.68)). Using the NHANES database yielded higher incidence rates among female patients with osteoporosis and more sensitivity in detecting incident fracture. Conclusion: Among older adults, BMD is a significant predictor for fragility fractures, and the association between diabetes and fractures remains equivocal. The NHANES database is superior to the Qatari database in detecting incident fracture cases among older Qatari women.

Introduction: Internationally, eight out of ten children are exposed to violent discipline by their caregivers. To reduce the prevalence of violent discipline against children, we should understand the social and economic factors that affect the choice of disciplinary methods. Despite the high prevalence of violent discipline in the Middle East and North African (MENA) region, only a few studies explored disciplinary methods in this region. Aim: This study aims to determine the prevalence of positive and violent disciplinary practices in five selected MENA countries and assess their association with household head education and beliefs of physical punishment. Methods: This is a cross-sectional study design based on available secondary data from the Multiple Indicator Cluster Survey on its fourth round (MICS-4). A child was selected randomly from the household, and the Parent-Child Conflict Scale (CTSPC) tool was used to report disciplinary methods the child encountered during the last month period preceding the survey. Univariate and multivariable logistic regression were used to investigate the association between disciplinary practices with household head education and respondent's beliefs of physical punishment. The analysis was conducted using pooled data from all selected surveys and also for individual countries. Result: The overall prevalence of positive discipline was only 15% (95% CI: 14.4-15.8), in the five countries, while the prevalence of violent discipline was 80% (95% CI: 79.0 -80.5). The prevalence of positive discipline was highest in Qatar (40%; 95% CI: 35.0-44.4) and lowest in Tunisia (5%; 95% CI: 4.3-5.9) while the prevalence of violent discipline was highest in Tunisia (93%; 95% CI: 92.1-94.1), and lowest in Qatar (50%; 95% CI: 44.7-55.0). Overall, the household head education was not significantly associated with either positive or violent discipline after adjusting for covariates. However, respondents believe of disciplinary methods were significantly associated with both positive and violent discipline (OR=5.88; 95% CI: 4.97-6.96) and (OR=6.27; 95% CI: 5.40-7.28), respectively. Conclusion: High rates of violent discipline in the MENA region might indicate an increase in mental, behavioral, and social problems and disorders in our future generation. Rapid action is needed to reduce the worsening of violent discipline, and it is consequences. There is a need for educational programs for caregivers to teach them alternative non-violent methods of discipline. Besides, these numbers should inform policymakers about the importance of the existence and the implementations of laws, policies, and regulations to protect children from all forms of violence to protect our future youths and ensure their health and wellbeing.

Background: Although autism is a global disorder, relatively little is known about the prevalence of consanguinity among autism spectrum disorder (ASD) individuals. Also, the relation of ASD comorbidities (Epilepsy and Intellectual Disability) to consanguinity have not been explored. Aims: We aim to estimate the global prevalence of consanguinity among the ASD individuals and compare it that among different populations. In addition, we aim document the prevalence of epilepsy and ID in relation to consanguinity in individuals diagnosed with ASD in Qatar and to assess the association between epilepsy and ID and consanguinity and other potential socio-demographic factors, environmental and other clinical factors. Methods: Meta-Analysis of observational studies reporting prevalence of consanguinity among ASD individuals from 8 countries were searched systematically in important databases including EMBASE, PubMed and Academic Search Complete. Individual studies were screened by two reviewers independently, extracted data and assessed the risk of bias using a risk of bias tool. Random Effect model was used to calculate pooled weighted estimates due to considerable heterogeneity. Subgroup analysis was also calculated. Moreover, secondary data were analyzed using the cross-sectional study on profiles and correlates of ASD clinical sample in Qatar. Descriptive, univariable and multivariable analysis were conducted to estimate the prevalence of consanguinity, epilepsy and ID among ASD individuals in this cohort and assess association to other potential confounding determinants. Results: The meta-analysis included 10 studies reporting prevalence of consanguinity among ASD cases. The pooled estimate of consanguinity among ASD cases was 24% (95%CI:17%-32%). Subgroup analysis by the study country led to a higher pooled estimate of consanguinity of 38% (95%CI:28%-49%) in the GCC countries compared to other than GCC countries with a pooled estimate of 16% (95%CI:11%-23%). The cross-sectional included a total of 171 ASD cases. Male to female ratio 4:1 and mean age was 13.5 years. Epilepsy was reported by 19%. ID reported by 83% of the cases. 76.6% were nonverbal. Eighty-three percent of the families had one proband, 9.9% had 2 probands, and 7.1% had more than two. The association between epilepsy and ID among ASD patients and consanguinity was not statistically significant (P value >0.05) controlling for other potential risk factors. Conclusion: The globally estimated pooled consanguinity prevalence among ASD patients was 24%, GCC countries showed a higher pooled prevalence (38%). The clinical sample used did not provide any evidence on association between both epilepsy and ID and consanguinity among ASD patients in Qatar. Further larger studies with much better large and representative sample may be required to confirm our results

Background: Inadequate physical activity (PA) is a serious public health problem among adolescents worldwide and in Qatar. Seeking information on health topics such as PA is increasingly documented among teens and may provide an opportunity for PA promotion. This study aimed at assessing the influence of information obtained from different sources on PA behavior change and identifying possible correlates of this change among Qatari adolescents Methods: The current secondary analysis was based on data from a nationally representative cross-sectional survey conducted in 2017 among 1050 Qatari students aged 13-19 years. Self-reported information on demographics, psychosocial factors, PA, and sources used to obtain health information were collected. Main outcome was the attempt to change PA behavior. Logistic regression analysis accounting for survey design information was carried out to examine the association between the outcome and information sources used to attempt PA change, and to find independent predictors for this attempt. Results: Nearly 68% of the respondents tried to change PA behavior (65% male versus 72% female), and 46% were physically active (55% males versus 38% females). Based on information from interpersonal, traditional, online, and social media sources about 65%, 55%, 51%, and 54% of adolescents respectively attempted to change their PA behavior. Results from multivariable logistic regression showed that teens who used information from interpersonal and online sources to try to change their behavior had 9 times (OR=9.35, 95% CI: 4.15-21.08, P

Objective To analyze the prevalence and characteristics of Healthcare Associated Infections (HAI) in patients with hematologic malignancies who underwent Autologous Hematopoietic Stem Cell Transplantation (AHSCT) at the National Center for Cancer Care and Research (NCCCR) newly opened transplant unit in Qatar between October 2015 and October 2016 with global comparison of the bloodstream Infection (BSI) prevalence, one of the most prevalent complications after stem cell transplant. Methods The Center of Disease Control (CDC) definitions for laboratory-confirmed bloodstream infection (BSI), modified criteria for pneumonia and hospital-acquired infections were used. Statistical analysis was done using STATA version14. The entire healthcare associated infections (HAI) and other variables were described using means, proportions and 95% confidence intervals. Meta-Analysis of Observational Studies in Epidemiology guidelines was applied in conducting the meta-analysis. The systematic search in English was done in PubMed from 1970 (date of stem cell transplant kick off) to 2016. Inclusion was restricted to human hematology studies that included AHSCT. Statistical calculations allowing an accurate estimation of the prevalence were calculated using MetaXl version 5.3. The data extraction for both studies was done independently by two reviewers. Results Out of the sixteen patients, three developed infection leaving the overall infection rate to 18.75%. Chemotherapy induced gastroenteritis was documented in 68.7% of the cases, chemotherapy induced mucositis was documented in 43.7% of the cases. Most of the infections occurred during neutropenia (92.3%) and 69.2% of them during febrile neutropenia. No gastroenteritis was microbiologically confirmed, all were clinically documented infections. Bacterial infections accounted for 12.5% (2/16 cases) one upper respiratory tract infection and one urinary tract infection. Whereas viral infections, pneumonia and urinary tract infections were each 6.25% (1/16 cases respectively). There was no prevalence of bloodstream infection or central line associated bloodstream infection for any of the patients. As for the meta-analysis, the aggregated results were studied in the 10 included studies. Significant heterogeneity was noted among the studies (I2 = 99%; P = 0.0001), the pooled prevalence of blood stream infection among 55789 AHSCT patients from the ten studies was 6%, 95% CI: 0, 33. Conclusion This study provides original baseline data about the prevalence of HAI among AHSCT in NCCCR. These findings will be used for additional evaluation of the influence of infection prevention and control measures and therapeutic plans for these patients. They will also contribute to the enhancement of the quality of care in NCCCR, mainly in the hematopoietic stem cell transplant unit (HSCT) through the proper implementation of the infection control standards and proper implementation of antimicrobial stewardship program.