Care In Egypt Research Articles

From reform to excellence: the future of health care in Egypt

From reform to excellence: the future of health care in Egypt

Health care providers’ perspectives on the need for palliative care in Upper Egypt: a descriptive exploratory study including children and adult patients

BackgroundOnly four centers in Egypt provide Palliative Care (PC) for adult cancer patients and one provides care for pediatric cancer patients. While PC is not widely utilized in Egypt, this study aims to assess patients’ need for PC from the providers’ perspective. The primary objectives were to assess providers’ knowledge about PC, understand patients’ needs, and compare children’s and adults’ needs for PC.MethodsA descriptive exploratory design was utilized. Patients were recruited from a cancer center in Qena Governorate, Egypt. All 108 nurses and physicians in the cancer center were interviewed to assess their perspectives about PC and patients’ need for it.ResultsOf the 108 care providers, more than 60% of the providers were not familiar with the concept of PC and did not participate in related activities, and more than 77% did not receive any training on the topic. All the providers reported there is no specific policy for end-of-life care. More than 60% of the providers responded that their patients do not need PC as the providers believe that PC provided only for end-stage patients. 50% of the providers see that PC has benefits such as pain relief and symptom management. No major differences were noted between pediatric and adult PC needs.ConclusionThe results of this study provide foundational evidence of providers’ lack of experience with and understanding of palliative care. This deficit is creating a barrier to providing palliative care in Egypt.

Microscopy detection and molecular characterisation of Giardia duodenalis infection in outpatients seeking medical care in Egypt.

Giardiosis remains one of the most prevalent enteric parasitic infections globally. Earlier molecular-based studies conducted in Egypt have primarily focused on paediatric clinical populations and most were based on single genotyping markers. As a result, there is limited information on the frequency and genetic diversity of G. duodenalis infections in individuals of all age groups. Individual stool samples (n = 460) from outpatients seeking medical care were collected during January-December 2021 in Kafr El-Sheikh governorate, northern Egypt. Initial screening for the presence of G. duodenalis was conducted by coprological examination. Microscopy-positive samples were further confirmed by real-time PCR. A multilocus sequence typing approach targeted amplification of the glutamate dehydrogenase (gdh), beta-giardin (bg), and triose phosphate isomerase (tpi) genes was used for genotyping purposes. A standardised epidemiological questionnaire was used to gather basic sociodemographic and clinical features of the recruited patients. Giardia duodenalis cysts were observed in 5.4% (25/460, 95% CI: 3.6-7.9) of the stool samples examined by conventional microscopy. The infection was more frequent in children under the age of 10 years and in individuals presenting with diarrhoea but without reaching statistical significance. Stool samples collected during the winter period were more likely to harbour G. duodenalis. All 25 microscopy-positive samples were confirmed by real-time PCR, but genotyping data was only available for 56.0% (14/25) of the isolates. Sequence analyses revealed the presence of assemblages A (78.6%, 11/14) and B (21.4%, 3/14). All assemblage A isolates were identified as sub-assemblage AII, whereas the three assemblage B sequences belonged to the sub-assemblage BIII. Patients with giardiosis presenting with diarrhoea were more frequently infected by the assemblage A of the parasite. This is one of the largest epidemiological studies evaluating G. duodenalis infection in individuals of all age groups in Egypt. Our molecular data suggest that G. duodenalis infections in the surveyed population are primarily of anthropic origin. However, because assemblages A and B are zoonotic, some of the infections identified can have an animal origin. Additional investigations targeting animal (domestic and free-living) and environmental (water) samples are warranted to better understand the epidemiology of giardiosis in Egypt.

An overview of childhood cancer care and outcomes in Egypt: a narrative review.

Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.

Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives.

In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly. Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain. Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2). The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.

Health coaching for hypertension control in primary care patients with uncontrolled hypertension in Egypt.

Health coaching effectively improves hypertension self-care activities and the control of blood pressure (BP) in hypertensive patients. Studies on the effects of health coaching on patients in primary care with uncontrolled hypertension in developing countries are limited. In this study, the effectiveness of health coaching on hypertension self-care and BP control was assessed in patients who have uncontrolled hypertension compared to standard care in Egypt. Our quasi-experimental study included control and intervention groups. The intervention group included 70 participants who received health coaching sessions (face-to-face and by telephone) besides the standard care, whereas the control group included 71 participants who only received the standard care. The study was conducted between July 2020 and November 2021. The participants were recruited from three primary healthcare settings in the Port Said Governorate. Personal and medical history, BP measurements, and hypertension self-care activity level effects (H-SCALE) were obtained. Paired-t-test was used to assess the changes in BP measurement, and H-SCALE score before and after receiving the health coaching. McNemar's test was used to assess changes in controlled BP and optimal hypertension self-care activities between control and health coached groups. Multiple logistic regression analysis assessed the predictors of better BP control. Health coaching resulted in more controlled BP (51.4%, P < 0.001) compared to the delivery of only usual care (11.3%, P = 0.008). The intervention showed a significant promotion in hypertension self-care activities, including medication usage (P < 0.001), low-salt diet (P < 0.001), and weight management (P < 0.001). The H-SCALE score mean change was the only predictor for BP control (odds ratio 1.057, P = 0.048) in the intervention group after 6 months. Intervention including traditional health coaching and phone calls is a beneficial modality for the promotion of hypertension self-care and improvement of BP control in primary care patients with uncontrolled hypertension.

Cognitive and psychosocial functioning in long-term survivors of pediatric hematopoietic stem cell transplant

Abstract Background Long-term survivors after hematopoietic stem cell transplant (HSCT) may encounter issues that lower their quality of life. Data on the psychological effects of HSCT in childhood are scarce. Morever, the effect of HSCT on cognitive function is regarded as a key issue. Objectives Assess survivors of HSCT for cognitive or psychological affection and explore their quality of life after HSCT. Patients and methods A cross-sectional Study was conducted on 25 long-term survivors of HSCT. The children psychological aspects were assessed using Pediatric Symptom Checklist (PSC), Self-esteem score of Rosenberg, Children Depression Inventory, Children anxiety scale, Pediatric Quality of Life (QOL),Wechsler III for IQ. Results The psychological evaluation scores of 14 males and 11 females showed that 28% of survivors had mild anxiety, 40% had a moderate anxiety and 32% had sever anxiety, according to PSC, 36% only reported emotional and behavioral problems. Regarding depression scale, 36% had mild depression and 12% had moderate depression and only 8% had severe depression. There was significant positive correlation between the survival period after transplantation and IQ (P value 0.008). There was statistically significant association between post-transplant infections and lower QOL (P value 0.047). Another significant association between chronic GVHD and lower self-esteem score (P value 0.031). Conclusion These findings brought to light ongoing issues with the cognitive and psychological evaluation of pediatric long-term survivors of HSCT, as well as the impact of chronic GVHD and post-transplant infection on their psychological evaluation, particularly on self-esteem score and QOL, respectively. Therefore, it is crucial to create focused treatments for pediatric HSCT care in Egypt. Psychologists must be a part of the transplantation care team.

The Determinants of Health Care Expenditure in Egypt

Abstract Health care sector is one of the most important sectors that affect the economies of all countries. On the one hand, it affects the productivity of labor force, on the other hand, it affects the spending of the households and the allocation of income among the various aspects of spending. In addition, the case of Egypt is characterized by some peculiarity in terms of The large population and the existence of a development gap between the cities of the north and the cities of the south, and the volume of out of pocket expenditure on health care which exceeds its counterpart in most countries of the world. In addition, health care service providers in Egypt are represented in the public sector, the private sector and the cooperative or community sector, where the three sectors provide health care services with different quality and prices. Therefore, this study aimed to identify the determinants of health care expenditure in Egypt through an econometric model. The results showed that spending on health care in Egypt was affected by percapita GDP and population over 65 years old while the econometric model shows no significance for variables such as hospital beds and number of medical doctors.

Access to emergency care in Egypt: Tiered health care and manifestations of inequity

Market-driven health care reforms and development strategies continue to drive the privatization of health care services across the world. When these measures are implemented, large disparities emerge and are maintained. Using a modified version of the access to care framework developed by Penchansky and Thomas, this paper examines the manifestations of inequity between private for-profit and public emergency care in the Greater Cairo Region and Asyut, Egypt. In-depth interviews with physicians working in both sectors reveals stark disparities in access between these two health care sectors in Egypt. Access issues identified include unaffordable care in the private sector, unavailable medical supplies and overcrowding in public hospitals, as well as a salary gap that drives health care workers from public to private practice, creating staffing shortages in public hospitals. The manifestations of these inequities are often severe, usually tangible, and according to health care providers, embodied in the experiences of service users.

Current status of outpatient heart failure management in Egypt and recommendations for the future.

Heart failure (HF) represents one of the greatest healthcare burdens worldwide, and Egypt is no exception. HF healthcare programmes in Egypt still require further optimization to enhance diagnosis and management of the disease. Development of specialized HF clinics (HFCs) and their incorporation in the healthcare system is expected to reduce HF hospitalization and mortality rates and improve quality of care in Egypt. We conducted a literature search on PubMed on the requirements and essential infrastructure of HFCs. Retrieved articles deemed relevant were discussed by a panel of 10 expert cardiologists from Egypt and a basic HFC model for the Egyptian settings was proposed. A multidisciplinary team managing the HFC should essentially be composed of specialized HF cardiologists and nurses, clinical pharmacists, registered nutritionists, physiotherapists, and psychologists. Other clinical specialists should be included according to patients' needs and size and structure of individual clinics. HFCs should receive patients referred from primary care settings, emergency care units, and physicians from different specialties. A basic HFC should have the following fundamental investigations available: resting electrocardiogram, basic transthoracic echocardiogram, and testing for N-terminal pro-B-type natriuretic peptide. Fundamental patients' functional assessments are assessing the New York Heart Association functional classification and quality of life and conducting the 6min walking test. guideline-directed medical therapy should be implemented, and device therapy should be utilized when available. In the first visit, once HF is diagnosed and co-morbidities assessed, guideline-directed medical therapy should be started immediately. Comprehensive patient education sessions should be delivered by HF nurses or clinical pharmacists. The follow-up visit should be scheduled during the initial visit rather than over the phone, and time from the initial visit to the first follow-up visit should be determined based on the patient's health status and needs. Home and virtual visits are only recommended in limited and emergency situations. In this paper, we provide a practical and detailed review on the essential components of HFCs and propose a preliminary model of HFCs as part of a comprehensive HF programme model in Egypt. We believe that other low-to-middle income countries could also benefit from our proposed model.

P010 Establishing a collaboration between the 4 university children’s hospitals in Egypt and the University of Michigan to improve cystic fibrosis care in Egypt

P010 Establishing a collaboration between the 4 university children’s hospitals in Egypt and the University of Michigan to improve cystic fibrosis care in Egypt

Reform of Mental Health care in Egypt, Telepsychiatry perspective

IntroductionThe World Health Organization (WHO) declared the outbreak of a new coronavirus disease to be a Public Health Emergency of International Concern. The situation now in Egypt, through the efforts done by the General Secretariat of Mental Health and Addiction Treatment (GSMHAT) which is governmental body following the Ministry of Health and Population: Establishment of 2 Hot lines for psychological counseling and Psychosocial support to working 24 hours/ 7 days a week. In the last year, the Mental Health platform is a main objective to be dedicated for Egyptian population, the national mental health platform is another milestone in the innovative digital remote MH services that is planned to be provided.ObjectivesEvaluating the effectiveness and feasibility of different mental health services provided by hospitals affiliated to General Secretary of Mental Health and Addiction Treatment, Ministry of Health during the COVID-19 pandemic outbreak including evaluation of remote delivery of mental health service and digital health solutions.MethodsObservational Cross-sectional study. All patients seeking the hotline service &amp; National Mental Health Platform, Evaluating the effectiveness and feasibility of services delivered over 12 months.ResultsThe platform’s statistical results since its launch showed that the number of visitors to the site is 44,105 and the number of registered users is 17,153. The number of self-requests conducted by users reached 16,318 and the number of virtual treatment sessions reached 2,797. The results also showed that the number of female users is 31%, compared to 69% of male users. The statistics showed that most of the age groups used for the site are between 15-20 years old, and that the users of the site are from all governorates, but most of the users are from the capital, Cairo. The statistical results also showed that general psychiatry with all its diseases is the most visited by the user of the site, followed by child and adolescent psychiatry subspecialty, then addiction.The GSMHAT, through the hotline, has provided services to the public represented by a number of calls ranging from April 2020 to March 2021 (8618) calls, and the GSMHAT hope that the hotline service to continue providing psychological counseling and support to those who wish, while continuing providing the service in hotline with the corresponding technical development and community needs.Conclusionsit is crucial to reallocate resources in order to serve for psychological and social needs and liaison psychiatry and digital as well as defining the barriers for providing a convenient service delivered by healthcare providers to people who are in need.Disclosure of InterestNone Declared

Impact of COVID-19 pandemic on cancer care: A cross-sectional study of Egyptian patients’ perspectives and concerns

BackgroundWorldwide, COVID-19 greatly reduced healthcare accessibility and utilization by non-COVID patients including cancer. This study aimed to quantify and characterize cancer care adjustments experienced by cancer patients/survivors; and to explore their concerns, beliefs, and knowledge regarding COVID-19. MethodsA cross‐sectional study was conducted using a questionnaire distributed through social media patients’ groups (June–December 2020). Questionnaire included basic information, care adjustments (in “care provision” and in “treatment plan”), and patients’ concerns, beliefs, and knowledge. Data description and analysis were done. ResultsOut of 300 participants, there were 68.0% on-treatment and 32.0% in follow-up stage. Care adjustments were reported by 29.7%; mostly in care provision (27.3%) rather than treatment plan (4.9%). Adjustments were less likely to occur when healthcare facility was in governorate other than that of residence (OR:0.53, 95%CI:0.30–0.96, P = 0.037) and more likely with long-standing diagnosis (≥12 months) compared with recent (<3 months) (adjusted-OR:4.13, 95%CI:1.19–14.34, P = 0.026). Lower proportion of on-treatment patients used remote consultation than patients in follow-up [4.4% versus 17.7%, P < 0.001].Patients were concerned about fulfilling their care visits more than the probable COVID-19 infection (72.3%). It was uncommon to feel that the risk of COVID-19 infection is higher in care places than in the community (27.3%) or to feel safe with remote consultations (34.3%). However, patients increased their infection control practice (64.0%) and the majority were aware of their increased susceptibility to complications (86.0%). Somewhat, they were also concerned about the care quality (57.3%). Many had adequate access to COVID-19 information (69.0%) and their main sources were the Ministry of Health webpage and ordinary media (radio/TV). ConclusionCancer patients were primarily concerned about fulfilling their planned care and COVID-19 infection was less appreciated. Policy summaryLaunching of a policy for enhancement of telemedicine experience through more patients’ engagement—as essential stakeholders—may be required. To heighten pandemic resilience for cancer care in Egypt, more investment in establishing specialized end-to-end cancer care facilities that ensure continuity of care may be justified.

Reviving Hearts That Were Born to Advocate for the Cause of Children and Youth Without Parental Care: Wataneya Society’s Youth Forum

In Egypt, there are 12,000 children in residential care; however, this figure is underestimated due to the number of unregistered care homes. Like elsewhere in the world, children raised in residential care in Egypt usually receive inadequate quality of care. Nevertheless, when they reach 18–21 years old, they are abruptly required to leave care and manage all the details of their lives, while often unsupported, unprepared and unequipped to make the move. In addition, they carry the burden of a strong societal stigma, affecting them psychologically and standing in the way of their personal, social and professional well-being. To support youths’ transition to independence, Wataneya Society launched the ’Youth Forum’ in 2017. To date, the Youth Forum targets youth aged 18 and above with the following objectives: (a) providing a safe space for the youth to exchange their thoughts and experiences; (b) enabling youth to discuss the challenges they face and come up with possible solutions; and (c) empowering youth to communicate their voice to the concerned authorities and equipping them with the needed skills to become agents of change to their cause. Years of regular meetups imprinted the Youth Forum’s ripple effects on Wataneya Society’s different projects, such as Sanad Conference in 2019, which was the first regional conference on leaving care in the Arab World; the Care Leavers independence programme, which is a programme to develop the after-care system in Egypt; and Mobader (meaning ‘being proactive’) programme, which is led by the youth to enable them to practise community leadership skills. This article will highlight case studies of two of the Youth Forum’s participants to demonstrate: (a) the main challenges children and youth in residential care in Egypt face that affect their transition to independence; (b) how the Youth Forum tackles those challenges through its main objectives, activities and development processes; (c) the main outcomes of the Youth Forum and how it is connected to Wataneya Society’s different projects and the reform of the alternative care system in Egypt; and (d) key learned lessons from the process of implementation of the Youth Forum. The article will employ a framework adopted from the World Health Organization (2017).

An Overview of Diabetes Mellitus in Egypt as a Major Public Health Problem

Abstract: Introduction: The prevalence of diabetes mellitus is rising rapidly in Egypt with major health and socioeconomic consequences. The shortage of endocrinologists is another important issue in Egypt that must be taken into consideration. Objective: To review and discuss the epidemiology, risk factors, and different ways of diabetes care in Egypt. In addition, the aim is also to analyze the problem of the shortage of endocrinologists and how it can be solved. Methods: Searching and reviewing medical literature using PubMed, Google scholar, and some other gray literature from the World Health Organization (WHO), International Diabetes Federation (IDF), and Centers for Disease Control and Prevention (CDC). Results: Egypt is ranked ninth in the prevalence of diabetes worldwide according to IDF with a prevalence of 15.2% in the adult population in early 2020. The prevalence is expected to continue rising to more serious levels. This high prevalence is attributed to common risk factors in Egypt such as obesity, physical inactivity, chronic hepatitis C infection, pesticides, smoking, and bad eating habits. Moreover, we are in an increased demand for more endocrinologists in the Egyptian health care system. Conclusion: Understanding and avoiding the risk factors of diabetes is a crucial step towards reducing its prevalence and minimizing its healthcare and socioeconomic burdens in Egypt. Effective strategies should be applied for proper diabetes management and improving the quality of life in diabetic patients. Increasing the number of endocrinologists is also a key element for better diabetes care. Keywords: Diabetes in Egypt, Diabetes epidemiology, Hepatitis C virus, Obesity, Smoking, Pesticides.

P667 Unmet needs in the management of Inflammatory Bowel Diseases in Egypt

Abstract Background Despite the progress in the management of inflammatory bowel diseases (IBD), there are still notable unmet needs in middle- and low-income countries. Defining those unmet needs will help improve patients’ care and quality of life. In this survey, our objective was aimed at exploring the current practice of physicians managing IBD patients in Egypt and the unmet needs in diagnosis, treatment, and medical education. Methods A web-based survey was designed. It was sent to clinicians via emails and followed up to track response rate. The survey was composed of six domains collecting demographic data, modalities used to diagnose patients with IBD, barriers, and challenges in managing IBD patients, availability of different diagnostic modalities and complementary specialties and policies to improve IBD care in Egypt, and finally the physicians’ needs and challenges in IBD training. Results Two hundred and eighty-eight physicians completed the survey. The mean age (±SD) was 36.22(±7.40) years and 69.44% were males. Endoscopic findings and histopathological examination were the most commonly used methods for IBD diagnosis (84.72% and 82.29% respectively). The most common challenges to IBD diagnosis in Egypt were the low availability of IBD multidisciplinary teams and non-informative histopathological reports (55.55% and 50.34% respectively). Expensive medications and poor adherence to therapy were the most important patients’ factors leading to poor IBD management (78.47% and 72.22% respectively). Physicians strongly preferred clinical rounds and case presentations rather than lectures and web-based learning (61.2 % versus 51.5% and 47.1% respectively). Most participants agreed that developing guidelines for IBD management, increasing IBD research, establishing patient access programs, and increasing IBD awareness among patients were the most important activities needed to Improve IBD care. Conclusion Lack of multidisciplinary/ complimentary teams, expensive medications, and poor adherence to therapy can lead to poor IBD management in Egypt. Developing guidelines for IBD management, increasing IBD research are urgently needed to Improve IBD patients’ care.

Early Dementia Questionnaire (EDQ): A Screening Instrument for early Dementia among elderly in Cairo governorate

Abstract Objectives To screen elderly participants for early Dementia in primary care in Egypt using a newly developed Early Dementia Questionnaire (EDQ) and comparing it with standard assessment tool, Mini Mental State Examination (MMSE). Design A cross-sectional study. Setting and Participants The study included 220 elder adults (both men and women) recruited from a primary healthcare center, the outpatient geriatric clinic at Ain Shams University hospitals and elderly clubs (Community dwelling) in Cairo Governorate, Egypt. Methods A cross-sectional study was conducted on a group of elderly patients using systematic random sampling. Elderly depression was excluded using the Geriatric Depression Scale (GDS). Diagnosed cases of dementia and other mental or psychiatric disorders and illiterate participants were excluded from the study. A face-to-face interview was done using EDQ with the participants to elicit symptoms of early dementia. The participants were then assessed with MMSE using variable cut-off points according to age and educational level. Results Prevalence of dementia among the study participants was 81.4% by EDQ and 19.5% by MMSE. The EDQ demonstrated a sensitivity of 97.7% with specificity of 22.6%. Positive predictive value of EDQ was 23.5% with the negative predictive value of 97.6%. A significant association was found between possible dementia, hypertension, Mini Nutritional Assessment and urinary incontinence. Conclusion The EDQ is more sensitive than MMSE for screening of early dementia.

Childhood cancer hospital resource utilization and costs in Egypt, 2013-2017; patterns, trends, and associated factors for 8886 patients from Children's Cancer Hospital, Egypt.

There is a lack ofevidence about resource use and costs of childhood cancer care in Egypt. Knowledge about resource use/costs can help in better resource planning to improve care and outcomes efficiently. In this study, we estimated patterns and trends of hospital resource use and costs for children with cancer (n=8886, aged 0-18 years) treated at Children's Cancer Hospital, Egypt (CCHE), between 2013 and 2017, by ICCC-3 groups, at one and three years post-diagnosis. We estimated costs from the healthcare provider perspective, expressed in USD 2019. We also studied resource use/cost trends, and factors associated with inpatient days and costs. For all cancers combined, median costs were $14,774 (IQR: $6,559-$23,738) at one year and $19,799 (IQR: $8,921-$34,204) at three years post-diagnosis. Median inpatient days were 38 days (IQR: 17-60) at one year, and 43 days (IQR: 20-74) at three years post-diagnosis. Patients with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and neuroblastoma imposed the greatest financial burden on CCHE, representing 53.1% of total costs. AML patients had the highest costs/resource use of all childhood cancers. Cost trends decreased by 2.9% (P<0.001) for all cancers combined, due to economic instability in Egypt between 2013 and 2017. The use of IV supportive drugs increased by 24.3% (P<0.001) over time for children with solid tumors. These findings will inform hospital resource planning and budgeting to promote value in care delivery, with implications for pediatric oncology practice and policy in Egypt/CCHE. Estimated costs provide the foundation for cost-effectiveness analysis.

Establishing a health economics and value unit at the Children’s Cancer Hospital–Egypt: Introducing a practical approach for evidence-based decision making.

e18859 Background: Health Economics is a multi-disciplinary practice that recently gained recognition in healthcare management systems. Value-based healthcare (VBHC) focuses on improving patient outcomes while using fewer healthcare resources. Integrating the principles of health economics and VBHC are essential to better inform decision-making based on evidence, especially in resource-limited settings, that need ultimate efficiency in managing resources. Egypt has the highest second estimated number of incident childhood cancer cases in the Eastern Mediterranean Region (EMR), based on GLOBOCAN 2020. Thus, childhood cancer in Egypt is an urging priority due to the large number of patients, limited resources, and poor outcomes. There is a need to optimize resource use and promote value in care delivery for childhood cancer care in Egypt, based on real-world evidence. Methods: This work aims to highlight the role of establishing a health economics and value (HEV) unit at the Children’s Cancer Hospital 57357 –Egypt (CCHE), to improve care and outcomes for children with cancer efficiently. CCHE is a not-for profit pediatric oncology center, treating around 50–60% of childhood cancers across Egypt free of charge. Results: The HEV unit was established in 2017 as a sub-function of the upper management at the hospital. The core mission of the unit is to translate health economics and VBHC concepts into practice to promote evidence-based decision-making, through applying the following functions and activities: monitoring trends in childhood cancer survival, resource use, and costs; applying health economic evaluation tools such as cost-effectiveness analysis (CEA) and multi-criteria decision analysis (MCDA); applying time-driven activity based costing (TDABC); implementing VBHC on a disease- and a hospital-level; monitoring costs and benchmarking. Some of these functions/activities reflect on operational processes such as integrating the CEA tools within the hospital procedures to maximize value of money spent; and restructuring hospital-wide cost centers for accurate costs reporting. Capacity building is also an important pillar in the unit’s framework, where the unit team conducts internal and external training sessions and workshops to spread the knowledge about health economics, VBHC, and evidence-based healthcare. Conclusions: The HEV unit at CCHE presents a unique model of applying health economics and value-based healthcare at a micro level in a pediatric oncology center in Egypt. This is a novel approach for healthcare management in Egypt and making informed decisions based on real-world evidence.

Perspectives on mental health recovery from Egyptian mental health professionals: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Personal recovery concept is dominant in mental health systems when service user involvement is emphasized; however, service user involvement in mental health research and practice does not exist in Egypt. Definitions of recovery from high-income and English-speaking countries should be carefully adapted to other settings. Nurses providing mental health care in Egypt generally do not have specialized mental health nursing qualifications. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Both cultural and contextual uniqueness of Egypt as a Middle Eastern, low-middle-income country were clear in the findings of this paper. There are differences in the definition of family and service user engagement in the current study and in high-income countries. Seeking faith healers as a barrier to mental health recovery is culturally unique. Functional recovery prevails as a model in Egypt as there is limited service user involvement. Nursing values and code of ethics are consistent with enablers of mental health recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Changing the pre-registration nursing education to prepare specialized graduates in mental health nursing. Training of mental health professionals on recovery approaches which involve service users is needed in Egypt. Mental health nurses in Egypt can use the current findings to implement national campaigns to raise public awareness of mental health problems. ABSTRACT: Introduction Recovery-oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. Aim To explore perspectives of Egyptian mental health professionals on recovery. Method Semi-structured interviews were conducted with 15 mental health professionals identified through snowball sampling. Results The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self-awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. Discussion The concept of functional recovery predominates among nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. Implications for Practice There is a need for nurses to be involved in designing intervention programs targeting the general public and to support increased involvement of people with mental health issues.