Search

N/A

More than three in 10 people living in Jordan are immigrants, with the majority being Palestinian and Syrian refugees, who have a very similar non-communicable diseases (NCDs) profile to the hosting Jordanian community. We conducted a rapid review of the literature of studies, reports, and documents on the evidence of the impact of COVID-19 on vulnerable populations in Jordan with regard to NCD during the first year of the pandemic. COVID-19-related mobility constraints and often lack of awareness of NCDs put additional burden on vulnerable populations like refugees and migrants, in particular on non-registered migrants. COVID-19 pandemic and associated mitigation measures led to disruption in routine health services, significantly impacting people living with NCDs. Ensuring to deliver a people-centered and inclusive approach that works well during COVID-19 is of paramount importance toward Universal Health Coverage (all people have access to the health services they need, when and where they need them, without financial hardship).

Background Healthcare workers have a 16 times greater risk of suffering workplace violence than workers in other sectors and around 50% experience workplace violence in the course of their career. The objective of this study is to explore the characteristics and circumstances of work-related killings of doctors. Methods Work-related homicides of doctors over the period 1988–2019 were identified retrospectively through the Italian national statistical agencies. Variables such as perpetrator, motive and location of the crime were obtained through forensic psychiatric work. After classification, the absolute and percent values of the main characteristics of the homicides were calculated. Results Over the period considered, 21 doctors were killed in Italy in connection with their professional activity. In 52% (n = 11) of cases, the killer was one of the doctor’s patients, in 29% (n = 6) of cases it was a patient’s relative, in 19% (n = 4) an occasional patient (first consultation). The location of the homicide was a community clinic in 48% (n = 10) of cases, the street in 19% (n = 4) of cases, the doctor’s home in 14% (n = 3), the hospital in 14% (n = 3) and the patient’s home in 5% (n = 1). In 57% (n = 12) of cases the perpetrator was not affected by any mental disorders. The motive for the homicide was revenge in 66.7% (n = 14) of cases; in 28.6% (n = 6) the revenge was preceded by stalking. Conclusions Doctors should be aware that the risk of being killed is not limited to hospital settings and that their patients’ family members might also pose a threat to them.

People with noncommunicable diseases (NCDs) are at a significantly higher risk of worst outcomes if infected with COVID-19 and thus amongst the main target population for vaccination. Despite prioritizing them for vaccination, the number of vaccinated patients with comorbidities stalled post vaccine introduction. Despite that the government along with partners ran a national awareness campaign to ramp up vaccination coverage, the coverage remained suboptimal. Thus, a one-to-one health counselling initiative was implemented to explore the acceptance of COVID-19 vaccines by the NCDs patients and address the main issues surrounding vaccine hesitancy. This study evaluates the impact of this intervention by analyzing the change in COVID-19 vaccine acceptance.In this analytical observational study, a random sample of 57,794 people living with NCDs were approached. Out of them, 12,144 received one-to-one counselling by a group of trained health professionals. The counselled group's vaccine acceptance was assessed on a Likert scale from 1 to 5 pre- and post- counselling. Moreover, a random sample was followed up 2 months after initial counselling to measure their vaccine acceptance and update their vaccination status.44.5% of total respondents were already registered in the vaccination platform. On a scale from 1 to 5, the overall mean confidence significantly increased by 1.63 from 2.48 pre-counselling to 4.11 post-counselling. Two-months post counselling, a random sample was contacted again and had a mean vaccine confidence of 3.71, which is significantly higher than pre-counselling confidence level despite a significant decrease to post-counselling results.Implementing an intervention that targets all key factors impacting health decisions, such as health literacy, risk appraisal and response efficacy, helps reach an adaptive response and increase vaccine confidence. Scholars should be cautious when implementing an intervention since it could lead to maladaptive defensive responses. One-to-one interventions are more effective in population when addressing new interventions and vaccines.

In 2021, Jordan was the first country to host the Global School for Refugee and Migrant Health, to improve the knowledge of the public health implications of migration. These perspective articles aim to retrieve salient reflections during the School as a baseline for further enhancement of migrant and health programs. During the School, a compilation of achievements, challenges, and opportunities was discussed around specific interrelated subjects, such as health system management and mental health. Successful examples were provided in the integration of refugees and migrants into health policies. On the other hand, the national health information systems are often not migrant-sensitive and evidence is still poor around mental health problems of refugees and migrants. Health financing remains a critical subject to address in a tailored way. The School highlighted the need to continue the exchange of experiences to promote a common approach to tackle similar needs.

Background Equity is a guiding principle of the Global Strategy for Women, Children and Adolescents’ Health (2016–2030) aimed at improving adolescent health and responding more effectively to adolescents’ needs. We investigated the socioeconomic differentials in having multiple sexual partners and condom use among unmarried adolescents who reported ever having had sex aged 15–19 years in 14 sub-Saharan countries. Methods Using the most recent publicly available Demographic and Health Surveys conducted between 2011 and 2018, we calculated survey- and sex-specific proportions of two or more partners and condomless sex, both overall and by selected socioeconomic characteristics and we fitted logistic regression models to estimate the survey- and sex-specific adjusted odds ratios. The pooled adjusted odds ratios were estimated using multilevel logistic regression. Results In most countries, higher percentages of male adolescents than female adolescents reported having more than one partner in the last 12 months. Conversely, a lower percentage of young male reported having condomless sex when compared to young female: from 19.8% in Gabon to 84.5% in Sierra Leone among male adolescents and from 32.6% in Gabon to 93.2% in Sierra Leone among female adolescents. In the multilevel analyses, condomless sex was associated with place of residence, wealth and schooling for both female and male adolescents, while among male adolescents multiple partnerships was significantly associated with place of residence. Conclusion Our findings on disparities in condomless sex associated with socioeconomic characteristics might reflect constraint choice and decision making. Results also suggest the need for educational programming and services and better access to barrier methods.

Objective:The current study explored changes in trend of anaemia and BMI among currently pregnant nullipara adolescent women against socio-economic determinants in India from 2005 through 2015. The association between anaemia in currently pregnant nullipara adolescent women v. currently pregnant nullipara older women of reproductive age was also explored.Design:We used the 2005 and the 2015 nationally representative Indian Demographic and Health Surveys (DHS). The outcomes of interest, anaemia and BMI, were measured based on the DHS methodology following WHO standards and indicators. Place of residence, educational attainment and wealth quintiles were used as determinants in the analysis.Setting:India.Participants:In total, 696 adolescent girls from the India 2005 DHS and 3041 adolescent girls from the India 2015 DHS.Results:The 10-year transition from 2005 to 2015 showed differences between the least and most wealthy sections of society, with heaviest gains in anaemia reduction over time among the latter (from 50·0 to < 40·0 %). The odds of anaemia were significantly higher among the adolescent population when compared with adult women both in 2005 and in 2015 (OR = 1·2).Conclusions:Despite an overall improvement in the prevalence of both BMI < 18·5 and anaemia among adolescents nullipara in India, the adjusted risk of anaemia in the latter category was still significantly higher as compared with their adult counterparts. Since the inequalities evidenced during the first round of DHS remained unchanged in 2015, more investments in universal health care are needed in India.

Background. The peak of sexually transmitted infections (STI) among adolescents/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a survey among freshmen from four Italian universities. Methods. This observational cross-sectional study was carried out with an anonymous self-reported paper questionnaire, administered during teaching lectures to university freshmen of the northern (Padua, Bergamo, and Milan campuses) and southern (Palermo campus) parts of the country. Knowledge of STI (a linear numerical score), knowledge of STI prevention (dichotomous variable: yes vs. no) and previous STI occurrence (polytomous variable: “no”; “don’t know”; “yes”) were the outcomes in the statistical analysis. Results. The final number of freshmen surveyed was 4552 (97.9% response rate). The mean age of respondents was 21.4 ± 2.2 years and most of them (70.3%) were females. A total of 60% of students were in a stable romantic relationship. Only 28% respondents knew the most effective methods to prevent STI (i.e., condom and sexual abstinence), with a slightly higher prevalence of correct answers among females (31.3%) than males (25.8%). Students with history of STIs were 5.1%; they reported referring mostly to their general practitioner (GP) (38.1%) rather than discussing the problem with their partner (13.1%). At multivariable analysis, a significantly higher level of STI knowledge was observed in older students (25+ years of age), biomedical students, and those from a non-nuclear family; lower levels were found among students of the University of Palermo, and those who completed a vocational secondary school education. Those who had less knowledge about the most effective tools to prevent STIs included males, students from the University of Palermo, students registered with educational sciences, economics/political sciences, those of foreign nationality, and those whose fathers had lower educational levels. The risk of contracting a STI was significantly lower only in students not in a stable relationship (relative risk ratio, RRR = 0.67; 95% confidence interval, 95%CI = 0.48; 0.94), whereas such risk was significantly higher in students with higher STI knowledge (RRR = 1.15; 95%CI = 1.08; 1.22). Discussion and Conclusions. University freshmen investigated in this study had poor knowledge of STIs and their prevention. Unexpectedly, those with higher levels of knowledge had an increased risk of STIs. There have been no educational interventions—with good quality and long-term follow-ups—that increased the confidence that such SHE programs could have population level effects. A new high-quality study is therefore recommended to assess the effectiveness of an intervention generating behavioral changes; increasing only STI knowledge may not be sufficient.

Background. The COVID-19 pandemic has imposed radical behavioral and social changes in the general population, significantly impacting the lives of individuals affected by disabilities. The aim of this study was to investigate the impact of COVID-19 on non-institutionalized subjects with sensorineural disabilities during the first COVID-19 wave in Italy. Methods. A 39-item online national survey was disseminated from 1 April 2020 to 31 June 2020 via social media throughout Italy to communities of individuals with proven severe sensorineural disabilities, affiliated to five national patient associations. The survey collected extensive information on the socio-demographic profile, health, everyday activities, and lifestyle of individuals with hearing and visual disabilities. Results. One hundred and sixty-three respondents with hearing (66.9%) and visual (33.1%) disabilities returned a usable questionnaire. The mean age of interviewees was 38.4 ± 20.2 years and 56.3% of them were females. Despite the vast majority of respondents (77.9%) perceiving their health status as unchanged (68.8% of interviewees with hearing deficits vs. 96.3% of those with visual impairments), about half the interviewees reported sleep disorders during lock-down, more likely those with visual deficits. Remote services were seemingly more effective for business than school activities. Furthermore, although just 18.8% of respondents rated remote rehabilitation care unsatisfactory, only 12.8% of interviewees felt supported by health and social services during the COVID-19 emergency. The vast majority of respondents were concerned about the future and the risk of SARS-CoV-2 contagion, particularly individuals with hearing impairments. Among the various risk mitigation measures, facemasks caused the greatest discomfort due to communication barriers, particularly among interviewees affected by hearing disabilities (92.2% vs. 45.7%). The most common request (46.5%) of respondents to reduce the inconveniences of the COVID-19 emergency was improving the access to and delivery of health and social services for individuals with sensorineural disabilities (19.3%), followed by the use of transparent masks (17.5%). Conclusions. Although health protection measures such as face masks and social distancing play a key role in preventing and controlling the spread of SARS-CoV-2, the unmet needs of disabled individuals should be carefully considered, especially those affected by sensory disabilities. Tailored access to health and social services for individuals affected by sensorineural disabilities should be implemented. Additional actions should include the use of face shields as a valid alternative to face masks to reduce communication barriers linked to hearing-impairment, as well as the improvement of remote services, especially distance learning at school.

Jordan is an upper-middle income country which was dramatically affected by two waves of COVID-19, the first wave in November 2020 and the second peaking mid-to-late March 2021. The country has developed its first National preparedness and response plan even before the first case of COVID-19 had been reported and has been being updating periodically. Similarly, Jordan has developed an effective plan for COVID-19 vaccine roll-out, thereby starting the registration to vaccination during late 2020. The aim of the vaccination program was changed from vaccinating 20% of the population to vaccinate over 5 million residents, corresponding to over 80% of the total population over the age of 18 years. Securing bilateral agreements and the ability to ensure additional vaccine supplies enabled the country to increase its vaccination target. Similar to equitable COVID-19 response in Jordan, COVID-19 vaccination plan includes all population, including refugees and migrants. 1.1. Strengthening existing immunization program The National Immunization Program (NIP) of Jordan is one of the most effective and successful public health programs which is highly trusted by the public. Country has reported immunization coverage rates over 90% for all vaccines during pre-COVID-19 period. A recent survey conducted by the World Bank reported that a country’s ability to roll out mass adult vaccination programs doesn’t depend on the existence of a well-functioning childhood immunization system [1]. This is evident through the recently established electronic registration, reporting, and monitoring system for COVID-19 vaccination. While childhood immunization is still relying on a paper-based vaccination electronic system, the COVID-19 vaccination data system is built on a solid electronic registration system, with minimal data entry.

OVID-19 has proved to be a social disease due to its widespread diffusion in the general population, the serious harm it causes on affected patients and its impact on the economy and social life of burdened countries. While socialization is a risk factor for the spread of the SARS-C0V-2, health protection measures such as isolation and lockdown further aggravated the “social” burden of COVID-19. Diseases with social impact require a management approach based on social medicine, integrating health, social and economic responses.

The role of face masks to prevent and control COVID-19 is critical, especially since asymptomatic or pre-symptomatic infected individuals can shed high loads of SARS-CoV-2 in the surrounding environment. In addition to being a two-way barrier to protect against virions droplets both in terms of “source control” (for the benefits of the community) and “physical protection” (for wearer), face masks also allow maintaining physiological temperatures and humidity of the nasal cavity and mouth, independently from the external environmental conditions. Beyond compromising the viral transmission speed, exposure to cold environments could have a detrimental effect on the host’s susceptibility to SARS-CoV-2. The innate human immune system becomes in fact weaker with cooler nose temperatures and thus more vulnerable to viral replication. Furthermore, there is evidence that warm, humid climates are associated with reduced spread of SARS-CoV-2, while cold dry conditions favor its stability and transmissibility. In the early stage of a viral infection, a physiological body temperature in the upper airways supports the innate immune system, endorsing the muco-ciliary clearance, inhibiting, or deactivating any first settlement of viruses. Face masks are therefore strongly recommended also outdoors, especially under cold weather conditions, not only as a physical barrier against the transmission of SARS-CoV-2, but also to prevent the rapid cooling of the nasal mucosa and the inhibition of the human innate defense of the upper airways.

n/a

A recent survey conducted by the World Health Organization (WHO) from June to August 2020 around the globe has clearly highlighted how the COVID-19 pandemic has disrupted or halted critical mental health services in 93% of the 130 countries under study despite the demand for mental health is increasing.

MERS-CoV was first recognized in 2012 as the cause of severe lower respiratory tract infection in humans and by the end of April 2021, a total of 2574 laboratory-confirmed cases and 886 associated deaths (case-fatality ratio 34.4%) were reported globally. On the other hand, the current COVID-19 pandemic has already caused almost 170 million cases and 3.5 million deaths worldwide.

IntroductionFertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs).MethodsWe searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings.ResultsWe screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents’ knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time.ConclusionThe available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.

BackgroundMental disorder is extremely common globally and integration of mental health in primary health services represents a critical gap especially in low- and middle-income Countries like Egypt. The World Health Organization has repeatedly called for effective training and support of primary care providers in the identification and treatment of mental health problems over the last decades.MethodsThis paper aimed to evaluate attitudes and knowledge of health care providers toward mentally ill patients and measure knowledge and retention of training messages over time. A 3-day mental health training workshop for nurses of public health facilities in the Governorate of Port Said was organized. Pre-training and post-training questionnaires (immediately after the workshop and 3 months later) were used. Significance of gain in scores was examined between baseline and following cross sectional rounds.ResultsThe 73 participants in the study revealed a statistically significant improvement in knowledge and attitude toward mental health from the baseline (pre-training), from a general mean score for desirable answers of 10.5 (± 1.2) to 21.2 (± 0.6). However, results slightly declined three months after from the workshop (18.5 (± 0.6)).ConclusionsIntensive short-term training on mental illness could be instrumental in improving knowledge and attitudes in countries like Egypt with extensive needs in terms of quality of comprehensive healthcare at primary and secondary level. However, additional evidence is needed to improve retention of information over time and to translate knowledge into clinical practice.

Background Over the past four decades, drought episodes in the Eastern Mediterranean Region (EMR) of the of the World Health Organization (WHO) have gradually become more widespread, prolonged and frequent. We aimed to map hotspot countries and identified key strategic actions for health consequences. Methods We reviewed scientific literature and WHO EMR documentation on trends and patterns of the drought health consequences from 1990 through 2019. Extensive communication was also carried out with EMR WHO country offices to retrieve information on ongoing initiatives to face health consequences due to drought. An index score was developed to categorize countries according vulnerability factors towards drought. Results A series of complex health consequences are due to drought in EMR, including malnutrition, vector-borne diseases, and water-borne diseases. The index score indicated how Afghanistan, Yemen and Somalia are “hotspots” due to poor population health status and access to basic sanitation as well as other elements such as food insecurity, displacement and conflicts/political instability. WHO country offices effort is towards enhancing access to water and sanitation and essential healthcare services including immunization and psychological support, strengthening disease surveillance and response, and risk communication. Conclusions Drought-related health effects in the WHO EMR represent a public health emergency. Strengthening mitigation activities and additional tailored efforts are urgently needed to overcome context-specific gaps and weaknesses, with specific focus on financing, accountability and enhanced data availability.

Summary box #### What is already known about this subject? #### What are the new findings? #### What are the recommendations for policy and practice? The ongoing COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), has affected 212 countries worldwide at various degrees as of 8 May 2020.1 In this paper we discuss a hypothesis that prior viral infections—either by SARS-CoV-2 or different strains of coronaviruses, or potentially even other respiratory viruses—may predispose to more severe forms of COVID-19, following a secondary infection with SARS-CoV-2. Most COVID-19 infections are asymptomatic or manifest with mild to moderate respiratory symptoms (fever, cough, sore throat, myalgia, fatigue and even non-severe pneumonia). Of patients with COVID-19, 14%–15% develop severe pneumonia and 5%–6% a critical condition requiring admission to intensive care unit (ICU).2–4 Death may eventually occur after an average of 17.8 days since the onset of symptoms.5 Among all countries, Italy (which was the first European COVID-19 cluster) presents a critical disease pattern as of 8 May 2020, having the third highest number of COVID-19 cases in the world after the USA and Spain, the fourth highest prevalence of the disease after Spain, Belgium and the …

While SARS-CoV-2 has infected millions and claimed more than 250,000 lives, experts are warning that the impact of other diseases neglected due to the pandemic may be just as significant in the months and years to come. Specifically, when health systems are overwhelmed, and people refrain from visiting health facilities due to movement restrictions or fears about illness exposure, both direct mortality and indirect mortality from preventable and treatable conditions increase.1-3 Female genital mutilation (FGM), also named female genital cutting, is acknowledged as a violation of human rights of women.4 The United Nations Sustainable Development Goals called for the elimination of the practice by 2030.5 FGM is referred to as any procedure involving the alteration or excision of external female genitalia without medical indication,6 and 3 million women in the world are estimated to be at risk of undergoing this procedure annually.6 It is a major public health problem in several countries in Africa and Middle East,6,7 being almost universal in seven African countries (prevalence >85%).6 A report from UNICEF highlighted how this practice is still being widely carried out in 29 countries in Africa and in Middle East, despite the fact that at least 24 of these countries have legislation or some form of decrees against FGM.8 However, some evident progress is ongoing: under the new FGM amendment to the criminal law in Sudan that was approved very recently (22 April 2020), anyone who performs FGM either inside a medical establishment or elsewhere faces three years' imprisonment and fine. 9 Studies conducted in different settings have clearly showed an adverse effect of FGM on psychological, sexual and reproductive health unfavourable outcomes. 10 This includes posttraumatic stress disorder,11 dyspareunia and genitourinary complications. Adverse obstetric outcomes, such as increased risk for caesarean delivery, episiotomy and postpartum haemorrhage, are also more frequent.12 Scar tissue, especially in women with FGM type III (infibulation) can result in obstructed labour or obstetric trauma.13 It is known that in situations of conflicts and disaster, gender inequality, gender-based violence and violation of human rights are likely to increase, as protection and health system are disrupted, leaving acts of violence unpunished and condoned by the societies. This applies to health emergencies as well, including the current COVID-19 pandemic. FGM, early marriage and violence against women and girls are life-threatening, health and human rights challenge, due to the inequal relations, and patriarchal rules.14 Survivors are left no choice or right of determination over their bodies, physical, and sexual and reproductive health. Estimates provided by Avenir Health, Johns Hopkins University (USA) and Victoria University (Australia) predict that significant levels of lockdown-related disruption over 6 months may cause significant delays in programmes to end female genital mutilation, potentially leading to around 2 million more cases of FGM over the next decade than would otherwise have occurred.15 These striking figures become even more daunting when compounded with the expected additional 31 million cases of gender-based violence and the 13 million more child marriages over the next 10 years.15 Support to continued access to reproductive health care services and protection of the rights and dignity of all women and girls remains even more critical in contexts such as the current pandemic. To do so, preparedness and response plans must incorporate and integrate Female Genital Mutilation in Gender-Based Violence, and Sexual and Reproductive Health Programmes, including in community awareness initiatives and activities, thus ensuring risk mitigation as well as remote and mobile case management.

The past two decades have witnessed a major shift in humanitarian operations to respond to more internal conflicts instead of the traditional cross-border wars. Over the recent years, two major shifts have taken place within the WHO to orient toward response to emergencies, namely the introduction of the Humanitarian Reform and the Cluster Approach in 2005 and the introduction of the Emergency Response Framework (ERF). The financing of the agency in humanitarian operations is adding emerging elements to the WHO operations, especially because of the constantly higher contribution from non-state- and state- funding agencies. Pending issues include aspects like health strategy, conflict analysis, legal issues of aid delivery, impartiality in delivering services, and other aspects and needs.

During the initial phase of the 2014-2016 Ebola virus disease (EVD) outbreak in Monrovia, Liberia, all hospitals' isolation capacities were overwhelmed by the sheer caseload. As a stop-gap measure to halt transmission, Medecins sans Frontieres (MSF) distributed household disinfection kits to those who were at high risk of EVD contamination. The kit contained chlorine and personal protective materials to be used for the care of a sick person or the handling of a dead body. This intervention was novel and controversial for MSF. This paper shed the light on this experience of distribution in Monrovia and assess if kits were properly used by recipients. Targeted distribution was conducted to those at high risk of EVD (relatives of confirmed EVD cases) and health staff. Mass distributions were also conducted to households in the most EVD affected urban districts. A health promotion strategy focused on the purpose and use of the kit was integrated into the distribution. Follow-up phone calls to recipients were conducted to enquire about the use of the kit. Overall, 65,609 kits were distributed between September and November 2014. A total of 1,386 recipients were reached by phone. A total of 60 cases of sickness and/or death occurred in households who received a kit. The majority of these (46, 10%) were in households of relatives of confirmed EVD cases. Overall, usage of the kits was documented in 56 out of 60 affected households. Out of the 1322 households that did not experience sickness and/or death after the distribution, 583 (44%) made use of elements of the kit, mainly (94%) chlorine for hand-washing. At the peak of an EVD outbreak, the distribution of household disinfection kits was feasible and kits were appropriately used by the majority of recipients. In similar circumstances in the future, the intervention should be considered.

The evolution of the COVID-19 pandemic in Jordan during the first 10 months of the epidemic was peculiar and can be easily categorized in three different phases: a first period featuring a very low number of reported cases, a second period with exponential growth from August with up to 8000 cases on the 18th November 2020, and a third phase with steady and progressive decline of the epidemiological curve. With the aim of better determine the entity of the population exposed to SARS-CoV-2, the Jordan Ministry of Health with the support of the WHO launched three rounds of the nationwide sero-prevalence survey. Using population proportionate to size (PPS) methodology, around 5000 individuals were selected from all Jordan governorates. Blood samples were collected from all participants and ELISA assays for total IgM, IgG antibodies to COVID-19 were used for testing at the National Public Health Laboratory. Results revealed that seroprevalence dramatically increased over time, with only a tiny fraction of seropositive individuals in August (0.3%), to increase up to more than 20-fold in October (7.0%) and to reach one-third of the overall population exposed by the end of 2020 (34.2%). While non age-specific trends were detected in infection rates across different age categories, in all three rounds of the seroprevalence study two out of three positive participants did not report any sign and/or symptom compatible with COVID-19. The serial cross-sectional surveys experience in Jordan allowed to gain additional insights of the epidemic over time in combination with context-specific aspects like adherence to public health and social measures (PHSM). On the other hand, such findings would be helpful for planning of public health mitigation measures like vaccinations and tailored restriction policies.

Background Scientific literature has provided clear evidence of the profound impact of sexual violence on women's health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia. Methods We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview. Results Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India. Conclusions Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy.

BACKGROUND: In spite of the last decade increase in availability of contraception, around half of the annual 21 million pregnancies notified in low- and middle-income countries in individuals aged 15-19 years are unintended. We sought to explore the contribution of the underuse of modern of contraception methods (MMC) to the annual incidence of unintended pregnancies among adolescent women. METHODS: We used Demographic and Health Survey (DHS) data from 12 low- and middle-income countries. The pooled analysis exploring the risk of unintended pregnancy included 1,717 adolescent women with a current unintended pregnancy and 29,304 currently not pregnant 15- to 19-year-old sexually active women who did not desire pregnancy. For each country and the pooled analysis, the odds ratio of unintended pregnancy was calculated in relation to the type of contraception (MMC, Traditional Methods, and No Contraception). Expected unintended pregnancies and population attributable fraction (PAF) of unintended pregnancies attributable to not using MMC were calculated for each country. FINDINGS: The use of traditional methods was associated with a 3·4 (95% CI 2·0-4·9) time increased odds of having an undesired pregnancy compared with the use of MMC of contraception while not using any method of contraception was associated with a 4.9 (95% CI 2·9-6·8) times increased odds. The population attributable fraction (PAF) of not using MMC accounted for 86·6% of the estimated unintended pregnancies (9,464,654 in total in the 12 countries) in the pooled analysis. PAF ranged from 62·7% (974,760) for Bangladesh to 95·1% (540,176) for Niger and the estimated number of unintended pregnancies because of the use of traditional methods or non-use of contraception ranged from 18,638 in Namibia to 4,234,916 in India. INTERPRETATION: Eight million out of 9·5 million unintended pregnancies occurring annually in twelve countries could have been prevented with the optimal use of MMC of contraception. MMC need to be further supported in order to further prevent unintended pregnancies globally. FUNDING STATEMENT: None. DECLARATION OF INTERESTS: The authors declare no competing interests. ETHICS APPROVAL STATEMENT: This analysis did not require additional ethical approval. The analysis relied upon publicly available dataset with no identifying data to guarantee participant anonymity. Ethics approval for the survey was obtained by the institutional review board of ORC Macro (Calverton, MD, USA) and country health authorities.

Purpose Identification of trends in the ability of young single women to protect themselves from unwelcome pregnancy is essential for evaluation and development of policies and programs. We document trends over a 15-year period in sexual activity, contraceptive use, and reproductive outcomes in four countries for single women aged 15–24 years. Methods Using retrospective month-by-month reproductive and contraceptive calendars, we constructed annual sexual, contraceptive, and reproductive profiles. The analysis was applied to all four countries (Colombia, Kenya, Peru, and Zimbabwe) that had collected complete reproductive calendars in three consecutive Demographic and Health Surveys. Women-years were classified as sexually inexperienced (i.e., virgin), sexually experienced but using contraception, and sexually experienced without contraception. Conception rates were calculated and those ending in live births were classified as wanted or unwanted. Results While virginity decreased over time in the Latin American countries, it increased in the African settings. The contribution of condom to the sexually active time protected by contraception use increased in all countries. While the percentage of conceptions ending in spontaneous or induced abortion increased in Colombia and Peru to around 15% of the total pregnancy outcomes, it decreased in the African countries to less than 6%. Conclusions Delayed sexual debut remains the major restraint on pregnancy in these four countries with the result that conception rates are very low. Condoms remain the most common method of contraception even in the two countries without severe HIV risks and efforts to displace condoms by nonbarrier methods should be pursued with caution.

Background Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. Methods We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Results Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0). Conclusions Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low- and middle- income countries to decrease early adverse neonatal outcomes.