1. Title: A survey to estimate direct and indirect costs due to tuberculosis and proportion of tuberculosis-affected households experiencing catastrophic costs due to TB in Alexandria, Egypt
Principal investigator: Dr. Ramy Mohamed Ghazy
Co-Pi: Dr. Rasha Mossalem, Heba Khedr
Funding agency: Joint WHO-TDR Small Grants Scheme (SGS) for implementation research in infectious diseases of poverty
Year: 2020-2021 (ongoing)
General objective:
To conduct a survey to estimate the direct and indirect costs due to tuberculosis and proportion of tuberculosis-affected households experiencing catastrophic costs due to TB in Alexandria, Egypt
Specific objectives:
- To determine the magnitude and main drivers of patient costs in order to guide policy makers on cost mitigation for the purpose of reducing financial barriers to access and adherence.
- To determine baseline percentage of diagnosed TB patients treated in the NTP network (and their households) in Egypt, who incur direct and indirect costs beyond a defined threshold of their annual income.
- To determine the correlation between facing costs above different thresholds of annual household income and the borrowing or selling assets to finance health care expenditure (or dissaving), in order to assess if the measure of dissaving is a sufficient metric of catastrophic total costs.
- To design a standardized approach for periodic measurements of financial barriers to adherence based on baseline experience and to enable future reporting.
2. Ramy Ghazy, the Lecturer of Tropical Health is the principal investigator of The Eastern Mediterranean Regional Office Special Grant for Research in Priority Areas of Public Health, (COVID-19 research section (RPPH 20-31) entitled (GIS-Based Model for analyzing spatial pattern and predicting COVID occurrence) (2020-2021) (ongoing)
Co-investigators: Prof. Mahmoud Adel Hassan, Professor of Human Geography and GIS Institute of Graduate Studies & Research (IGSR) Alexandria University, Egypt.
General objective:
To develop GIS-Based Model for Analyzing Spatial Pattern and Predicting COVID Occurrence
Specific objectives:
a. Analyzing spatial variations of COVID19 cases and delineating the main hotspots.
b. Exploring various determinants of COVID-19 spatial pattern of occurrence.
c. Identifying the most significant predictors of COVID-19 occurrence.
d. Spotting deaths and assess if there are death hot spot areas.
3. Ramy Ghazy, the assistant lecturer of Tropical Health is the principal investigator of WHO-RPPH Research priority in Public Health research grant entitled: "Causes and Distributions of Under-Five Mortality in Alexandria Governorate Using the Verbal Autopsy and Social Autopsy Studies Interview". (RPPH 18-83) (2018-2019)
Co-investigator: Mohamed Tahoun, Lecturer of Epidemiology
General objective:
To identify causes and distributions of under-five mortality in Alexandria Governorate using the verbal autopsy and social autopsy studies interviews.
Specific objectives:
- To identify age-specific cause of death among under-five children.
- To determine causes of mortality in rural, and urban areas.
- To Validate the role of VASA as a tool for determining the cause of under-five mortalities.
Results:
The response rate to VASA was 66%. Neonatal mortality, post-neonatal mortality, and child mortality represented 70.1%, 24.5%, and 5.4% of U5M respectively. There was no statistically significant difference between males and females in cause-specific mortality fraction (CSMF), P > 0.05. The main UCODs among neonates were preterm delivery (57.3%), congenital malformation (17.3%), congenital pneumonia (10.8%), birth asphyxia (8.4%), and stillbirth (3.1%). The most-reported UCODs among post-neonates and children were pneumonia (25.9%), childhood cardiovascular diseases (22.8%), digestive system diseases (11.9%), and diarrhea and dysentery (7.8%). The main UCODs among under-five children were preterm delivery (40.2%), followed by congenital malformation (12.1%), pneumonia (7.8%), congenital pneumonia (7.6%), childhood cardiovascular diseases (6.8%), and birth asphyxia (5.9%). Communicable diseases, maternal, neonatal, and nutritional diseases caused 72.0% of U5M, while non-communicable diseases and injuries caused 25.7% and 2.4% of all U5M, respectively.
4. Ramy Ghazy, the assistant lecturer of Tropical Health is the principal investigator of Joint WHO-TDR Small Grants Scheme (SGS) for implementation research in infectious diseases of poverty (SGS18-95) entitled: "Determinants of Schistosoma mansoni transmission in hotspots at the late stage of elimination, Kafr El Sheikh governorate". (2018-2019)
Co-investigators: Mai Badr, Lecturer of Environmental Chemistry & Biology
Nehad Taktak, Assistant Lecturer of Vector Control & Pesticides Risks
Mohamed Tahoun, Lecturer of Epidemiology
General objective:
To study the determinants of Schistosoma mansoni transmission in hotspots at late stage of elimination, Kafr El Sheikh governorate
Specific Objectives:
- To estimate the prevalence of human S. mansoni infection in correlation to environmental factors seasonally.
- To assess the prevalence of snail infection in correlation to environmental factors.
- To carry out a malacological survey of the intermediate host seasonally.
- To evaluate the role of socio-economic and behavioral factors affecting the prevalence of S. mansoni infection.
Results:
Prevalence of S. mansoni infection was significantly higher during summer (19.1%) than during fall (7.2%), p <0.01. The intensity of infection (light, moderate, and high) during summer versus fall was (93.55% vs 89.38%, 6.45% vs 8.85, and 0.00% vs 1.77%), p<0.05. Higher prevalence of human infection was identified among males than females (OR=1.63), children aged 11-15 years than among counterparts aged 6-10 years, (OR=2.96), and if mothers were of low educational level (OR=2.83). The main identified risk factors were contacting the main body of water-canal for either washing clothes, land irrigation, collecting waters, bathing, and garbage disposal, p<0.05. The count of collected Biomphalaria Alexandrina was statistically different across seasons (p<0.01) in conjugation with a similar significant difference in water temperature, salinity, turbidity, total coliforms concentration, depth, velocity, and level, p<0.01. Presence of grasses and duckweeds had a significant association with snail infection (p = 0.00l). Water depth, pH, temperature, and total dissolved salts (TDS) significantly affected the snail count.
5. Noha Ossama, the assistant lecturer of School Health is the Principal Investigator of the WHO/EMRPPH grant project number (RPPH 16-105), entitled: "Health Seeking Behavior and Medical Management of Pneumonia among under Five Children in Alexandria, Egypt; Mothers’ Perspective" (2016-2017).
Co-investigators: Yasmine Yousry Muhammad Ahmad Muhammad, Lecturer of Maternal & Child Health
Ayat Diaa El Din Mohamed Saber Ashour, Lecturer of Geriatric Health
General objective:
To identify health seeking behavior and medical management of pneumonia among under five children in Alexandria, Egypt; Mothers’ Perspective.
Specific objectives:
- To address mothers’/ primary care givers’ health seeking behaviors for their suspected pneumonic/ pneumonic under-five children.
- To assess first medical management received for pneumonic under-five children from mothers’ perspective.
- To investigate barriers in management of pneumonic under-five children from mothers’ perspective.
Results:
We found that 57.2% of children received home treatment before seeking medical advice. Around 26% of mothersWe found that 57.2% of children received home treatment before seeking medical advice. Around 26% of motherswaited ≥ 2 days before seeking medical advice; insufficient knowledge about the disease was their main contention (89%).Factors significantly associated with the delay were: rural residence (P = 0.006); low income (P = 0.002); home treatmentgiven before seeking medical advice (P < 0.001) and previous episodes of pneumonia (P = 0.002). Diagnosis of pneumoniahad not been made by more than half of the first consulted sources (52.7%).
6. Ramy Ghazy, the assistant lecturer of Tropical Health is the principal investigator of Joint WHO-TDR Small Grants Scheme (SGS) for operational research in communicable diseases (SGS 16-27) (RPD. 11/1) entitled: "Evaluation of PCR Assay for Detection of Schistosoma mansoni DNA in Human Stool Samples". (2016-2017)
Co-investigator: Mohamed Tahoun, Lecturer of Epidemiology
This study aimed at:
- To determine the prevalence of S. mansoi in a single stool sample collected from the study group by Kato-Katz and PCR.
- To evaluate the validity of and performance of PCR in detection of S. mansoni.
- To determine the prevalence of S. mansoni after conventional therapy with PZQ.
Results:
The prevalence of S.mansoni after examination of single stool sample of 347 individuals aged (5-15 years old) based on four slides KK was (106/347) 30.5%. Regarding intensity of infection 87.7% of infected children were of low intensity meanwhile, high and moderate infection represented 5.7% and 6.6% respectively. The wet mount had a sensitivity and PPV of 5% and 40%, respectively, and had a specificity and NPV of 98.5% and 85.5%, respectively. Cohen’s Kappa coefficient (k) was 0.05 indicates poor agreement between wet mount and KK test. The cPCR had a sensitivity and PPV of 25.7% and 100%, respectively, and had a specificity and NPV of 100% and 71.4%, respectively. Cohen’s Kappa coefficient (k) was 0.31 which indicates poor agreement between cPCR and KK technique.