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Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.

We present a score for assessing the quality of ICU care in terms of structure and process, based on bibliographic review, expert consultations, field test, analysis, and final consensus, and analyze its initial application in the field. This feasibility and observational study was conducted within the framework of a French regional clinical research project (NosoQual); 40 ICUs were visited and assessed between November 2002 and March 2003 according to standardized procedures. The grid consisted of 95 variables. The overall score derived from seven independent quality dimensions: human resources, architecture, safety and environment, management of documentation, patient care management, risk management of infections and evaluation, and surveillance. The average level of achievement of the scores varied from 48% to 63% of theoretical maxima. Variability in the individual dimensional subscores was greater than that of the overall score (CV = 0.15). Evaluation this scoring system encounters the limitation of the absence of a “gold standard.” However, this is counterbalanced by the rigorous design methodology, the characteristic strengths of the quality dimensions. The survey also highlights also feasibility and the potential interest for specific tools for the assessment of ICUs.

Sufficient laboratory capacity is essential to effective infectious disease surveillance and control. This is recognized in the current International Health Regulations (IHR), which identify laboratory services as a category of core capacities that all the World Health Organization (WHO) Member States are expected to develop and maintain ( 1 ). IHR Core Capacity 8 requires laboratory services for every phase of real-time event management (i.e., detection, investigation, and response), with sample analysis being performed either domestically or through collaboration centers ( 2 ). (Published: 25 January 2013) Citation: Emerg Health Threats J 2013, 6 : 19960 - http://dx.doi.org/10.3402/ehtj.v6i0.19960