Hoda Rashad

Demographic transition in Arab countries: A new perspective

This paper provides a new perspective on the fertility transition in Arab countries. It shows that the story of Arab fertility must be retold: the story is of a region with the highest fertility preferences, exhibiting reluctance to change due to the stranglehold of cultural forces, and just starting to respond to development forces. The paper shows that Arab regional experience is quite comparable to that of other developing countries and that, though the fertility decline occurred at a somewhat later date, the pace of decline more than compensates for this delay. Furthermore, the probing of country level experiences and forces underlying the transition shows the diversities of these experiences and the exaggeration of the role of cultural specificity. It also demonstrates that a large part of the decline in Arab fertility is due to changes in nuptiality. For some segments of society and some countries, these changes are not paralleled by increased opportunities for women to have more fulfilling lives. For these women, the fertility decline is not necessarily improving the quality of their lives and cannot be equated with progress and development.

Oral rehydration therapy and its effect on child mortality in Egypt.

This paper attempts to assess the demographic effect of the Egyptian National Control of Diarrhoeal Disease Project which was launched in February 1984 to reduce dehydration-specific mortality resulting from acute diarrhoea. The program was aimed at increasing the use of oral rehydration therapy defined as the use of oral rehydration salts at the onset of diarrhoeal attacks as well as continued feeding especially breast feeding during diarrhoeal episodes. This study analyzes the demographic effect of the program and provides guidelines for future evaluation studies to test casual relationships between health intervention programs and observed changes in mortality. The 1st double-round survey was carried out in 1984-1985 covering 10739 children and the 2nd in 1985-1986 covering a similar number of children. Mortality statistics for Egypt indicate strong declines in mortality rates and in diarrhoeal-associated mortality. The existence of a national program for control of diarrhoeal disease has led to the general feeling that the program has shown its effect on mortality. The fact that association does not imply causation is not always welcome especially when when proving causation is not straightforward. The analysis does not disprove the demographic effect of the program but for conclusions to be expressed more positively it is necessary to eliminate some of the flaws.

Health equity in the Arab world: the future we want.

Executive summary In the past few decades, the Arab region as a whole has made significant strides forward in health development and in improving the overall health and life expectancy of populations. However, the region also faces tremendous health challenges. A new Lancet Series focuses on priority health issues in the Arab world, based on evidence interpreted mainly by scholars from the region, and adopts a multidisciplinary approach that includes medical, public health, social, and political perspectives

Measurement of health equity as a driver for impacting policies.

This paper proposes measurement tracks of health equity (HE) and presents practical illustrations to influence, inform and guide the uptake of equity-sensitive policies. It discusses the basic requirements that allow the effective use of the proposed measurement tracks. Egypt is used as a demonstration of this practice. The paper differentiates between the policy needs of two groups of countries. The first set of measurement tracks are specifically tailored to countries at the early stages of considering health equity, requiring support in placing HE on the policy agenda. Key messages for this group of countries are that the policy influence of measurement can be strengthened through the implementation of four self-reinforcing tracks that recognize the need to effectively use the available current databases prior to engaging in new data collection, emphasize the importance of a social justice reframing of the documented health inequities, present health inequity facts in simple visual messages and move beyond the why to what needs to be done and how. The tracks also recognizes that placing an issue on the policy agenda is a complex matter requiring reinforcement from many actors and navigation among competing forces and policy circles. For the second group of countries the paper discusses the monitoring framework. The key messages include the importance of moving toward a more comprehensive system that sustains the monitoring system which is embedded within affective participatory accountability mechanisms. The paper discusses the basic requirements and the institutional, financial, technical and human capacity-building considerations for implementing the proposed measurement tracks.

Refugees in the eastern Mediterranean region

2476 www.thelancet.com Vol 386 December 19/26, 2015 3 Pareek M, Baussano I, Abubakar I, Dye C, Lalvani A. Evaluation of immigrant tuberculosis screening in industrialized countries. Emerg Infect Dis 2012; 18: 1422–29. 4 Tebruegge M, Ritz N, Koetz K, et al. Availability and use of molecular microbiological and immunological tests for the diagnosis of tuberculosis in Europe. PLoS One 2014; 9: e99129. 5 Basu Roy R, Sotgiu G, Altet-Gómez N. Identifying predictors of interferon-gamma release assay results in pediatric latent tuberculosis: a protective role of bacillus Calmette-Guerin? A pTB-NET collaborative study. Am J Respir Crit Care Med 2012; 186: 378–84. 6 Borrell S, Español M, Orcau A, et al. Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona. Clin Microbiol Infect 2010; 16: 568–74. 7 Abubakar I, Laundy MT, French CE, Shingadia D. Epidemiology and treatment outcome of childhood tuberculosis in England and Wales: 1999–2006. Arch Dis Child 2008; 93: 1017–21. opted to simply modify their original guidelines they developed before the migration crisis. Some countries are exclusively aiming to identify adults with active tuberculosis, arguing that this screening will restrict transmission within refugee centres and to the resident population. However, this strategy neglects addressing the reservoir of tuberculosis that is latent tuberculosis infection. Epidemiological evidence shows that progression of latent tuberculosis infection to active tuberculosis usually occurs within the fi rst 2 years of arrival and that children have the highest risk for progression. Recognition of tuberculosis symptoms needs to be integrated into immediate health assessments of refugees, including children and adolescents. Long-term assimilation of arrivals into health-care systems should include screening for both latent and active tuberculosis, as well as training primary and emergency treatment service in vigilance for and recognition of tuberculosis symptoms in this vulnerable population.