AIM: To investigate the epidemiology of Helicobacter pylori (H. pylori) infection among the healthy asymptomatic population in Iran and countries of the Eastern Mediterranean Region.
Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to c...Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to curb wastage of resources to ensure sustainable access of the population to needed and effective health services without enduring financial hardship.This study aims to assess total factor productivity change of national health systems of 20 countries in the WHO’s Eastern Mediterranean Region.Methods:Data Envelopment Analysis(DEA)-based Malmquist index is used to assess total factor productivity change and its components-efficiency change and technical change.To assess the robustness of the Malmquist index estimates,bootstrapping was performed.Outputs used are life expectancy at birth for both sexes and infant mortality;while total expenditure on health per capita in international dollars(PPP)is used as a measure of input.Panel data for the period 2003-2014 was extracted from databases of the WHO and the World Bank.Results:In all but five countries covered in the study,a decline in the mean total factor productivity is observed during the period 2003-2014.The decline is driven by technical regress.In all countries,the technical change component of the Malmquist TFP index is less than unity(range:0.896 to 0.945).All countries exhibited growth in efficiency(efficiency change exceeding one)except two countries(Djibouti and Iraq).The growth in efficiency was mainly due to change in scale efficiency.Overall,total factor productivity in the region declined by 3.8%.This was due to a 9.1%decline in technical change,which overshadowed the 5.8%increase in efficiency.Three countries-Libya,Qatar and Yemen-showed a marginal growth in total factor productivity.There was no change in total factor productivity in Kuwait and Lebanon.Conclusion:The decline in total factor productivity over the study period is likely to hamper achieving the targets of Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages.It is recommended that country-level studies on efficiency and productivity of health systems be conducted in order to intensively examine the determinants of inefficiency and productivity decline and implement appropriate interventions that could enhance efficiency and productivity.展开更多
BACKGROUND The presence of hepatitis C virus(HCV)RNA in liver tissue or peripheral blood mononuclear cells with no identified virus genome in the serum has been reported worldwide among patients with either normal or ...BACKGROUND The presence of hepatitis C virus(HCV)RNA in liver tissue or peripheral blood mononuclear cells with no identified virus genome in the serum has been reported worldwide among patients with either normal or elevated serum liver enzymes.The characterization of occult HCV infection(OCI)epidemiology in the Middle East and Eastern Mediterranean(M and E)countries,a region with the highest incidence and prevalence rates of HCV infection in the world,would be effective for more appropriate control of the infection.AIM To estimate the pooled prevalence of OCI in M and E countries using a systematic review and meta-analysis.METHODS A systematic literature search was performed using international,regional and local electronic databases.Some conference proceedings and references from bibliographies were also reviewed manually.The search was carried out during May and June 2020.Original observational surveys were considered if they assessed the prevalence of OCI among the population of M and E countries by examination of HCV nucleic acid in peripheral blood mononuclear cells in at least 30 cases selected by random or non-random sampling methods.The meta-analysis was performed using Comprehensive Meta-analysis software based on heterogeneity assessed by Cochran’s Q test and I-square statistics.Data were considered statistically significant at a P value<0.05.RESULTS A total of 116 non-duplicated citations were found in electronic sources and grey literature.A total of 51 non-overlapping original surveys were appraised,of which 37 met the inclusion criteria and were included in the analysis.Data were available from 5 of 26 countries including Egypt,Iran,Pakistan,Saudi Arabia,and Turkey.The overall prevalence rate of OCI was estimated at 10.04%(95%CI:7.66%-13.05%).The lowest OCI rate was observed among healthy subjects(4.79%,95%CI:2.86%-7.93%).The higher rates were estimated for patients suffering from chronic liver diseases(12.04%,95%CI:5.87%-23.10%),and multi-transfused patients(8.71%,95%CI:6.05%-12.39%).Subgroup analysis indicated that the OCI rates were probably not associated with the studied subpopulations,country,year of study,the detection method of HCV RNA,sample size,patients’HCV serostatus,and sex(all P>0.05).Meta-regression analyses showed no significant time trends in OCI rates among different groups.CONCLUSION This review estimated high rates of OCI prevalence in M and E countries,especially among multi-transfused patients as well as patients with chronic liver diseases.展开更多
文摘AIM: To investigate the epidemiology of Helicobacter pylori (H. pylori) infection among the healthy asymptomatic population in Iran and countries of the Eastern Mediterranean Region.
文摘Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to curb wastage of resources to ensure sustainable access of the population to needed and effective health services without enduring financial hardship.This study aims to assess total factor productivity change of national health systems of 20 countries in the WHO’s Eastern Mediterranean Region.Methods:Data Envelopment Analysis(DEA)-based Malmquist index is used to assess total factor productivity change and its components-efficiency change and technical change.To assess the robustness of the Malmquist index estimates,bootstrapping was performed.Outputs used are life expectancy at birth for both sexes and infant mortality;while total expenditure on health per capita in international dollars(PPP)is used as a measure of input.Panel data for the period 2003-2014 was extracted from databases of the WHO and the World Bank.Results:In all but five countries covered in the study,a decline in the mean total factor productivity is observed during the period 2003-2014.The decline is driven by technical regress.In all countries,the technical change component of the Malmquist TFP index is less than unity(range:0.896 to 0.945).All countries exhibited growth in efficiency(efficiency change exceeding one)except two countries(Djibouti and Iraq).The growth in efficiency was mainly due to change in scale efficiency.Overall,total factor productivity in the region declined by 3.8%.This was due to a 9.1%decline in technical change,which overshadowed the 5.8%increase in efficiency.Three countries-Libya,Qatar and Yemen-showed a marginal growth in total factor productivity.There was no change in total factor productivity in Kuwait and Lebanon.Conclusion:The decline in total factor productivity over the study period is likely to hamper achieving the targets of Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages.It is recommended that country-level studies on efficiency and productivity of health systems be conducted in order to intensively examine the determinants of inefficiency and productivity decline and implement appropriate interventions that could enhance efficiency and productivity.
文摘BACKGROUND The presence of hepatitis C virus(HCV)RNA in liver tissue or peripheral blood mononuclear cells with no identified virus genome in the serum has been reported worldwide among patients with either normal or elevated serum liver enzymes.The characterization of occult HCV infection(OCI)epidemiology in the Middle East and Eastern Mediterranean(M and E)countries,a region with the highest incidence and prevalence rates of HCV infection in the world,would be effective for more appropriate control of the infection.AIM To estimate the pooled prevalence of OCI in M and E countries using a systematic review and meta-analysis.METHODS A systematic literature search was performed using international,regional and local electronic databases.Some conference proceedings and references from bibliographies were also reviewed manually.The search was carried out during May and June 2020.Original observational surveys were considered if they assessed the prevalence of OCI among the population of M and E countries by examination of HCV nucleic acid in peripheral blood mononuclear cells in at least 30 cases selected by random or non-random sampling methods.The meta-analysis was performed using Comprehensive Meta-analysis software based on heterogeneity assessed by Cochran’s Q test and I-square statistics.Data were considered statistically significant at a P value<0.05.RESULTS A total of 116 non-duplicated citations were found in electronic sources and grey literature.A total of 51 non-overlapping original surveys were appraised,of which 37 met the inclusion criteria and were included in the analysis.Data were available from 5 of 26 countries including Egypt,Iran,Pakistan,Saudi Arabia,and Turkey.The overall prevalence rate of OCI was estimated at 10.04%(95%CI:7.66%-13.05%).The lowest OCI rate was observed among healthy subjects(4.79%,95%CI:2.86%-7.93%).The higher rates were estimated for patients suffering from chronic liver diseases(12.04%,95%CI:5.87%-23.10%),and multi-transfused patients(8.71%,95%CI:6.05%-12.39%).Subgroup analysis indicated that the OCI rates were probably not associated with the studied subpopulations,country,year of study,the detection method of HCV RNA,sample size,patients’HCV serostatus,and sex(all P>0.05).Meta-regression analyses showed no significant time trends in OCI rates among different groups.CONCLUSION This review estimated high rates of OCI prevalence in M and E countries,especially among multi-transfused patients as well as patients with chronic liver diseases.
