North Lebanon Research Articles

First report on seroprevalence and risk factors of Toxoplasma gondii infection in sheep and goats in North Lebanon.

Toxoplasmosis is of dual importance in both public and veterinary health due to the respective risk of transplacental transmission in primo-infected pregnant women and economic losses caused by abortions in mammals. One of the main routes of Toxoplasma gondii transmission to humans is the consumption of raw or undercooked meats containing parasitic cysts. Here, we performed the first epidemiological study to determine the seroprevalence and the risk factors of toxoplasmosis in livestock in Lebanon. Using a modified agglutination test with a cut-off of 1:40, we tested the positivity rate of Immunoglobulin G antibodies in the sera of 100 sheep and 80 goats collected from 18 different livestock farms located in North Lebanon between March and June 2018. Anti-Toxoplasma gondii IgG antibodies were detected in 42% of sheep and 34% of goats. Adults (> 1 year) were significantly more infected by T. gondii than the lambs (< 1 year) in both species (p < 0.05). These findings indicated that food animals are highly exposed to T. gondii in Lebanon and could be potentially a major risk factor of T. gondii infection to humans. Consequently, national prophylactic strategies should be implemented to control and to prevent T. gondii transmission between animals and humans.

Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study.

ObjectivesPatients with mental health disorders often have to endure the burdens of the condition itself and the stigma that follows. Since no study has been conducted in Lebanon on this topic, our objective was to assess the knowledge, attitude and behaviors towards public stigma of mental health diseases, among a sample of the Lebanese population.MethodsA cross-sectional study, conducted between November 2017 and May 2018, enrolled 2289 participants. The Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward Mental Illness (CAMI) and the Reported and Intended Behavior Scale (RIBS) were used to assess knowledge, attitude and behaviors toward mental illness respectively. The 25th, 50th and 75th percentile of the MAKS, CAMI and RIBS scales scores were considered as cutoff points for low, medium and high scores respectively.ResultsA high knowledge score was found in 33.0% of the participants, whereas a high attitude score and a higher behavior score were found in 32.2% and 26.9% of the participants respectively. Living in North Lebanon (Beta = 1.331) and being familiar with a non-close person with mental illness (Beta = 0.811) were associated with higher knowledge of mental illness (higher MAKS score), whereas living in Bekaa (Beta = -8.693) and being 70 years old and above (Beta = -5.060) were associated with lower knowledge toward mental illness (lower MAKS score). Higher knowledge of mental illness (higher MAKS score) (Beta = 0.670), having a high level of education (university (Beta = 8.785), secondary (Beta = 6.084) and technical (Beta = 5.677)) were associated with less stigmatizing attitudes (higher CAMI scale). Being familiar with close people with mental illness (Beta = 0.577), less stigmatizing attitudes (higher CAMI scale) (Beta = 0.077) and higher knowledge of mental illness (higher MAKS score) (Beta = 0.115) were associated with higher favorable behaviors (higher RIBS score), whereas knowing a non-close person who have a mental illness (Beta = -0.720) was associated with lower favorable behaviors (lower RIBS score).ConclusionA mass media awareness campaigns that could transmit health messages to a wide public audience in the country to fight stigma toward mental illness, seems warranted.

Molecular epidemiology of Campylobacter isolates from broiler slaughterhouses in Tripoli, North of Lebanon

ABSTRACT 1. The real burden of Campylobacter spp. in Lebanon is still unknown. The aims of this study were to unravel the epidemiology of Campylobacter spp. in broilers at slaughterhouses in Tripoli, North of Lebanon and to characterise their antibiotic resistance profiles. 2. From May to November 2015, sampling was performed through five repeated surveys from 15 slaughterhouses that sold chicken directly to Lebanese customers. Isolates were subjected to pulsed field gel electrophoresis (PFGE) and flaA-restriction fragment length polymorphism (flaA-RFLP). 3. All investigated slaughterhouses were found to be positive for Campylobacter spp. Campylobacter coli was the predominant species (38 isolates) followed by C. jejuni (eight isolates). A noticeable level of resistance was detected among isolates against ciprofloxacin (97% of C. coli and 87.5% of C. jejuni), amoxicillin (89% of C. coli and 75% of C. jejuni), gentamicin (79% of C. coli and 50% of C. jejuni), and co-amoxiclav (24% of C. coli and 25% of C. jejuni). Erythromycin and ertapenem resistance were observed only in C. coli with the following percentages 74% and 13% respectively, but not in C. jejuni. PFGE and flaA-RFLP using DdeI as restriction enzyme divided the strains into 27 and 25 types respectively. 4. The high observed genetic diversity of Campylobacter spp. revealed the complexity of the spread of this genus in broilers. This study highlighted the pressing need to monitor antibiotic resistance and to ensure food safety from ‘farm to fork’ in Lebanon.

Assessment of Antibiotic and Pesticides Residues in Breast Milk of Syrian Refugee Lactating Mothers.

Occupational exposures and current diet are both sources of environmental contaminants that can be transferred in the mother’s body. These chemicals can definitely penetrate to the developing foetus and the nursing infant from contaminated breast milk during the lactation period. Nowadays, one of the special interests is the exposure of new-borns to toxic chemicals such as pesticides and antibiotics reported in human milk due to their potential harms, especially developmental deficits in early childhood. The aim of our current study was to assess the occurrence of pesticide residues and antibiotic residues contamination in breast milk collected from Syrian refugee lactating mothers residing in North Lebanon Camps. A total of 120 breast milk samples (40 in triplicate) were collected from camps in Akkar, North Lebanon using an electrical pump. A survey was administrated to determine socio-demographic characteristics, dietary and smoking habits and medical history of participating lactating mothers. The milk samples were analysed for the presence of antibiotic residues and pesticide residues using liquid and gas chromatography tandem mass spectroscopy (LC-MS/MS) and Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS). This study reported the absence of antibiotic residues in 96.66% of our samples (n = 120) and the presence of pesticides residues in only 5% of our total breast milk sample. Our results considered the breast milk collected from Syrian refugee lactating mothers as safe from chemical contamination. It is worth conducting more studies on other Syrian refugee camps to test the effect of camp living conditions on breast milk safety.

Bioaccessibility and radioisotopes of lead in soils around a fertilizer industry in Lebanon.

The use of phosphate ore by fertilizer industries is considered a major source of soil contamination by trace metals and radionuclides. Despite its low mobility and bioavailability, lead (Pb) is among soil contaminants that pose a serious risk to human health. This study evaluates the potential impact of a fertilizer factory in North Lebanon on the total content of Pb and the activity concentration of its radioisotopes in residential, non-agricultural lands around the industry, as well as its mobility and bioaccessibility in soil samples collected at different depths. Chemical extractions by EDTA and in vitro physiologically based extraction test were used to estimate, respectively, the available and bioaccessible fractions of Pb in soils. Radioisotopes 214Pb, 212Pb and 210Pb have been analyzed by gamma spectrometry. Different physicochemical soil parameters, such as pH, carbonate content, electrical conductivity, cation exchange capacity, clay, total nitrogen and redox potential, were studied. The pseudo-total Pb varied between 12.8 and 68.5mgkg-1, while the extractable fractions were more variable, between 12 and 72% of total Pb concentration for the EDTA extracted fraction and up to 28.5% for the bioaccessible fractions. The processing of the data shows the decreases with depth in most sites of the total and available Pb and of the activity concentration of 210Pb and their positive correlations with total nitrogen. These variations and relationships with the location of studied sites show the influence of emissions from the factory or the transport of ore and by-products. The correlations between available and bioaccessible Pb on one hand, between available Pb and 210Pb on another hand, raise the question of health risk assessments taking into account the bioaccessibility of Pb and its radioisotopes.

Risk assessment of asbestos-cement roof sheets in Chekka, North Lebanon

Asbestos-cement was manufactured and used in Lebanon since the early 1950s. Corrugated rooftops of asbestos-cement were mostly spread within residential areas throughout the country. These rooftops are subject to weathering factors which are known to increase friability and risk of hazardous fiber release. This study aimed at assessing the asbestos-cement rooftop friability and the possible emerging risks in the urban-industrial city of Chekka, North Lebanon. The evaluation of the asbestos-cement included two field assessment algorithms and a standardized pull-up test. Hazard of fiber emissions was assessed by a pull-up test method, whereas vulnerability was determined by a level of interaction between people and the rooftops. Geographic object-based image analysis was used to map hazard, vulnerability, and risk of asbestos rooftops in the study area. The field algorithms classified most rooftops in a bad state compared with the pull-up test which ranked most of them as good. The X-ray diffraction analysis showed the presence of serpentine and amphibole fibers, except for crocidolite, in some rooftop samples. Hazard, vulnerability, and risk maps of the sampled area showed how hazard potential was amplified by vulnerability of population to possible fiber emission.

Cutaneous leishmaniasis in north Lebanon: re-emergence of an important neglected tropical disease.

Cutaneous leishmaniasis (CL) is the most prevalent neglected tropical disease among externally displaced people in the Middle East. In recent years, the Lebanese population has increased >30%, mainly due to a mass influx of Syrian migrants, thousands of them carrying CL, among other infectious diseases. Here we revisit the current CL prevalence among refugees in northern Lebanon. This cohort study was conducted at the Al Bashaer Medical Center in north Lebanon between January and June 2017. A total of 48 randomly selected suspected CL patients were clinically diagnosed by dermatologists and samples were obtained for microscopic examination and molecular identification by polymerase chain reaction restriction fragment length polymorphism. The treatment response to antimonials was assessed each week and was followed for up 6 months. Leishmania tropica was the predominant species (91.7%) followed by Leishmania major (8.3%). Confirmed cases were treated with one to two courses of antimonials and healing was usually achieved after receiving a second course of treatment. Importantly, we show evidence of possible local CL transmission by indigenous sandflies in three separate patients who had no history of recent travel to Syria. This highlights the urgent necessity to implement preventive disease strategies to avoid further dispersion of L. tropica CL in north Lebanon.

A CHILD-FRIENDLY CITY: A YOUTH CREATIVE VISION OF RECLAIMING INTERSTITIAL SPACES IN EL MINA (TRIPOLI, LEBANON)

Although old Arab cities were designed bottom-up to follow the needs of their users, public spaces for use by children were not fully considered. This paper is an outcome of a funded project that hosted 30 youth (aged 13–17 years old) from different parts of El Mina city, located in the North of Lebanon, Tripoli. The project’s aim was not limited to capacity building or designing a framework for youth participation as a vision for a child-friendly city alone, as it also demonstrated community participation with the youth to realize a design vision in an unused interstitial space by the youth in the ancient city of El Mina. The funded project consisted of many different stages; this paper focuses on the site selection, design process and the final stage of implementation. The results highlight the lessons learned from the youth’s participation, the adaptive reuse of interstitial spaces, in addition to the various interests of the project’s stakeholders.

Fracturing Communities: Aid Distribution in a Palestinian Refugee Camp

This article examines the practices of humanitarian aid distribution from the perspective of aid recipients rather than providers through an immersion in the daily home life of Palestinian residents of Nahr al-Barid refugee camp (north Lebanon) in 2011. It argues that in the name of distributing aid fairly, humanitarian aid providers put in place a pervasive system of surveillance to monitor, evaluate, and compare residents' misery levels by relying on locally recruited aid workers. This regime of visibility was designed to be one directional; NGOs never disclosed how much aid they had available, nor when or how it would be distributed. The inclusion of local aid workers in this opaque framework turned a process that relied on community and neighborhood ties into an impersonal machine that fostered doubt and suspicion and ultimately hindered the community's ability to engage in collective political action.

Specialized Rural Pain Clinics: Lessons for a Small Country like Lebanon

Background: People with chronic pain and who live in rural communities often lack access to pain specialists. They end up relying on primary care providers who may be less prepared to deal with their conditions. Purpose: The purpose of this study is to survey the existence of specialized pain clinics/services in rural Lebanon. It also aims at highlighting the importance of the existence of such clinics/services rurally. Method: A review of the literature about pain in Lebanon was conducted using PubMed, Medline, Google Scholars, and Research Gate. Another search was conducted using Google Maps to locate any specialized pain clinics in the rural areas. The Lebanese Society for Pain Medicine was also contacted for information about the distribution of specialized pain clinics/services in Lebanon. Results: Our results showed that the total number of pain clinics/services in Lebanon is ten. They are distributed as follows: Five in Greater Beirut including Metn (50%), one in North Lebanon (10%), two in South Lebanon (20%), one in Beqaa (10%), and one in Mount Lebanon (Chouf, Aley, Kesrouan/Jbeil) (10%). The majority (90%) of these services are hospital-based and are governed by the Anesthesia Departments. Moreover, a comprehensive palliative care approach towards pain management in terminally-ill cancer and non-cancer patients is still lacking nationwide. Conclusion and implications: Rural Lebanon is still significantly underserved as far as the existence of specialized pain clinics is concerned. This calls for a quick interference by the health officials considering the fact that a significant proportion of Lebanese people live in the rural areas. In parallel, the international approaches to palliative care for chronic pain should be adopted. Lastly, an alternative to out-of-pocket payment for the consultation fees and treatments should be taken into consideration

Does Education Help the Transition out of Power-Sharing in Plural Societies? A Comparative Study

This paper investigates the relationship between education policy and transition out of power-sharing by comparing the archetypal case study of the Netherlands to five contemporary typical cases of deeply divided societies which adopted power-sharing to manage their conflicts (Bosnia and Herzegovina, the Republic of North Macedonia, Iraq, Lebanon, and Northern Ireland). It shows that education systems generally reproduce rather than challenging power-sharing, particularly through separate and unequal schools. However, flexible institutional designs in education (as well as the wider political system) can accommodate shifting identities, ultimately facilitating transition out of consociation over the long term.

First report on the prevalence and subtype distribution of Blastocystis sp. in dairy cattle in Lebanon and assessment of zoonotic transmission

Blastocystis sp. is frequently identified in a wide range of animal hosts, including bovids. Because of its burden and zoonotic potential, this parasite has been sought in domestic cattle from various countries, since this livestock may also represent a possible reservoir of human infection. However, epidemiological data regarding the prevalence and ST distribution of Blastocystis sp. in this animal group is lacking in Lebanon. Therefore, faecal samples were collected from a total of 254 dairy cattle raised on 55 farms located in the North Lebanon region and screened for the presence of the parasite by quantitative real-time PCR. The overall prevalence of Blastocystis sp. was shown to reach 63.4% in cattle livestock. Sequence analysis of positive samples indicated the presence of seven STs, with predominance of ST10 (44.0%) and ST14 (36.8%) and lower proportions of ST2 (8.0%), ST1 (7.2%), ST5 (2.4%), ST3 and ST7 (0.8% each). This survey was the first conducted worldwide reporting ST2 and ST7 in domestic cattle and confirmed that ST10 and ST14 represent cattle-adapted STs in view of their high prevalence. Faecal samples from in-contact dairy farmers and patients hospitalised in the same Lebanese governorate who reported no contact with cattle livestock were also analysed for the presence of Blastocystis sp. The same three STs were identified in both human cohorts, with predominance of ST3, followed either by ST1 or ST2 depending of the group. No other STs, including ST10 or ST14, have been reported. Moreover, even though ST1, ST2 and ST3 were found to be common to dairy cattle and farmers cohorts, only one ST3 isolate showed 100% sequence identity between both hosts. Consequently, the presence and low prevalence of ST1, ST2, ST3, ST5 and ST7 identified herein in domestic cattle, most of which exhibit low host specificity, could be derived from occasional direct exposure to faecal material from human and non-human hosts or by ingestion of contaminated drinking water or food in the enclosure of the farms. Together with the absence of ST10 and ST14 in the human population, these data suggest that cattle play a negligible role as zoonotic reservoirs of Blastocystis sp.

Optimization of a DI-SPME-GC–MS/MS method for multi-residue analysis of pesticides in waters

This paper discusses the optimization and validation of a complete and simple method for the simultaneous determination of 48 pesticides in water by combining direct immersion solid-phase micro-extraction (DI-SPME) and gas chromatography-ion trap tandem mass spectrometry (GC-ITMS/MS). For the extraction, the different SPME parameters were tested and optimized. As a result, the polyacrylate fiber (PA 85 μm) was selected in direct immersion mode; the extraction temperature was set to 60 °C with an extraction time of 45 min and a stirring speed of 500 rpm; the thermal desorption time of the fiber in the injector port was fixed to 10 min at 275 °C. Concerning the analysis, MS/MS parameters were optimized and figures of merit were compared. Later, the method was validated and showed good linearity in the concentration ranging from 0.05 to 100 μg L−1. The reproducibility of measurements expressed as the relative standard deviation (% RSD) was found to be satisfactory. Furthermore, the detection limits for all the compounds were between 0.001 and 0.458 μg L−1, except for methomyl and hexachlorobenzene (1.09 and 0.99 μg L−1 respectively). Finally, the proposed DI-SPME-GC–MS/MS method was tested successfully for water samples collected along the watershed of Abou Ali River (North Lebanon).

Recent changes in welfare indicators among Palestinian refugees in Lebanon: a comparative study of two cross-sectional datasets

BackgroundPalestinians in Lebanon have been protracted refugees for 70 years, but the Syrian crisis has caused shocks that threaten to destabilise their already fragile livelihoods. Over a million Syrian refugees and 42 000 Palestinian refugees from Syria have fled to Lebanon, adding pressure to an already weak infrastructure and labour market. The United Nations Relief and Works Agency (UNRWA), the main provider of health, education and relief services to Palestinian refugees, is exceptionally strained. This study examines changes in education, health, employment, food security, and poverty indicators for Palestinian refugees in Lebanon (excluding Palestinian refugees from Syria) using two nationally representative household surveys conducted in April, 2010, and July, 2015. MethodsThe surveys were conducted using multi-stage cluster random sampling. Both surveys included households residing in camps and gatherings. Health conditions were reported for all household members by a proxy survey respondent from among the household members. Food insecurity was assessed using the Arab Family Food Security Scale. The poverty lines (thresholds) were set at US$6·84 per person per day (upper poverty line) and US$2·47 per person per day (extreme poverty line) in 2015, and US$6 per person per day (upper poverty line) and US$2·17 per person per day (extreme poverty line) in 2010. The difference across the 2 years reflects adjustment for inflation rates within the 5-year period. Data were analysed using STATA13. The study was approved by the Institutional Review Board of the American University of Beirut. Informed verbal consent was obtained from the survey respondents. FindingsOf the eligible sampled households of Palestinian refugees in Lebanon, 88% (2974 of 3382) in 2015 and 99% (2593 of 2626) in 2010 gave informed consent and completed the questionnaire. Net enrolment rates for elementary education remained high (98% in 2015 and 95% in 2010), but failed to lead to better labour market outcomes. The unemployment rate increased from 8% in 2010 to 23% in 2015, and the fraction working in elementary occupations increased from 23% to 36%. Overall poverty remained unchanged but with considerable regional shifts: poverty increased by 9% and 11% in central Lebanon and north Lebanon, respectively, whereas it dropped by 8% and 9% in Saida and Tyre. Extreme poverty was halved from 7% to 3%. There was a high prevalence of chronic diseases in both years (37% in 2015 and 31% in 2010); and in 2015, out-of-pocket health expenditure was six times higher when the household reported at least one chronic condition (US$50·9 per capita per month compared with US$8·3 per capita per month). Despite the reduction in extreme poverty, 4% of households shifted from moderate to severe food insecurity. InterpretationPressures on UNRWA services come at a time when the organisation is operating with a large shortfall in funding. Recent US funding cuts may have dire repercussions for a population burdened by a high prevalence of chronic conditions and facing high healthcare costs. With additional budgetary strains and worsening labour market conditions, Palestinian refugees in Lebanon risk losing some of the ground that they have gained in net enrolment rates in education, access to health-care services and the reduction in extreme poverty that the UNRWA has worked towards for decades. FundingUNRWA funded the data collection for both surveys.

Geotechnical and Numerical analysis of Bcharreh Landslide stability

The aim of this study is to shed light on a real stability problem within the region of Bcharreh located in North of Lebanon where roads have no protection against landslides. An attempt for landslide assessment that occurred in November 2016 is presented in order to analyse the different factors behind the landslide and find the trigger factor affecting the stability of the slope. The characterization of soil properties along the slope is done based on geotechnical investigation, and data collection. The first part of work consists of site inspection and geotechnical investigation followed by a series of laboratory tests to evaluate the mechanical properties constituting the slope, in addition to collection of topographical and hydrogeological data. The second part presents the numerical analysis where a finite element model simulating the slope conditions is generated using Plaxis 2D in order to reproduce the process of landslides, to assess slope stability and determine the overall factor of safety in both dry and wet conditions. The contribution of each causal factor in prompting soil movement is then demonstrated and explained.

Prevalence and correlates of a positive screen for eating disorders among Syrian refugees.

The objective of this cross-sectional study was to examine the prevalence and correlates of a positive screen for eating disorders (EDs) in a sample of Syrian refugees living in North Lebanon. The study was conducted on a convenience sample of 450 (84.67% women and 15.33% men) refugees, aged between 18 and 45years. The prevalence of a positive screen for ED was 5.79%. Bivariate analyses revealed that female gender (p=0.02), presence of medical conditions (p=0.01), old occurrence of major stressful life event (p<0.01), and positive primary care post-traumatic stress disorder screen (p<0.01) were associated with the positive sick, control, one stone, fat, food tool. Multiple logistic regression analyses showed that subjects screened with post-traumatic stress disorder had a three times higher risk of having a positive screen for ED (odds ratio=3.2; 95% confidence interval [1.32, 7.78]). Early detection of ED and related factors may help identify refugees who would benefit from interventions to improve mental health.

Chemical and Sensorial Characteristics of Olive Oil Produced from the Lebanese Olive Variety ‘Baladi’

The olive oil quality, nutritional and sensorial characteristics are associated with the chemical composition, which is the result of a complex interaction between several environmental, agronomical and technological factors. The aim of the present study is to investigate the impact of the geographical origin, harvesting time and processing system on the chemical composition and sensorial characteristics of olive oils produced from the Lebanese olive ‘Baladi’. Samples (n = 108) were collected from North and South Lebanon, at three different harvesting times and from four processing systems. Results showed a strong effect of origin, processing system and harvest time on oil quality, fatty acid composition, total phenols and OSI. The early harvest showed higher total phenols content (220.02 mg GAE/Kg) and higher OSI (9.19 h). Moreover, samples obtained from sinolea and 3-phases recorded the lowest free acidity (0.36% and 0.64%), and the highest OSI (9.87 and 9.84 h). Consumers were not unanimous regarding the studied factors, although samples recording high ranks were mostly from South using sinolea, 3-phases and press systems at early and intermediate harvest. The overall findings suggest that the selection of the harvesting time and of the processing system could have significant influence on the characteristics of the olive oil.

Length-weight relationships and relative condition factor of fish inhabiting the marine area of the Eastern Mediterranean city, Tripoli-Lebanon

Length-weight relationships (LWRs) and relative condition factor are of great importance in fishery assessment studies since it provide information about the growth of the fish, its general wellbeing, and fitness in a marine habitat. LWRs for 9 fish species collected from the marine area of Tripoli-El Mina, North Lebanon, were established, and their growth condition was evaluated. The results indicated that almost all captured species exhibited a negative allometric growth and tended to be thinner. A significant difference was observed between b values during the warm and cold periods for Liza ramada, Oblada melanura and Epinephelus costae. In terms of seasonal variation, Liza ramada exhibited a positive allometric growth only in winter, while Oblada melanura had a positive allometric growth during the summer. The relative condition factor (Kn) fluctuated between 0.99 and 1.00, indicating a state of well-being for these fish species. The current study provided the first baseline data about LWRs and relative condition factor of fish species from the Eastern Mediterranean city of Tripoli. Such data is valuable for establishing a monitoring and management system of these fish species.

Elementary Mathematics Teachers’ and Coordinators’ Perceptions about Teaching Problem Solving in North Lebanon Private Schools: an Exploratory Mixed Study

The purpose of this mixed research study was to explore how teaching problem solving is taking place at the elementary level in north Lebanon private schools, and to understand the challenges students were facing from the teachers’ and coordinators’ perspective. Four instruments were used: An inventory sent to 273 private schools, a teacher’s questionnaire, a coordinator’s interview, and class observations. Findings revealed that out of 129 Mathematics teachers who responded to the inventory, 126 (97%) affirmed using active learning strategies (ALS). To examine how Mathematics teaching is taking place, five private English speaking schools were purposefully selected to participate in the study with five Mathematics coordinators and ten teachers. The results showed inconsistency between the inventory, coordinators’ interviews, teachers’ responses to the questionnaire, and class observations. While responses to the inventory and teachers ‘questionnaires showed that at least 60% of teachers use ALS, class observations revealed that teachers did not make use of strategies that engage students in learning or in monitoring their progress and understanding. Moreover, teachers’ and coordinators’ responses to some questions showed that students’ difficulties were due to two main reasons: language barrier and poor analytical skills. Recommendations for teachers’ training on specific active learning strategies and adequate English language usage to teach mathematics were suggested.

Establishing a Rural School of Nursing in Lebanon: A Practical Model

Background: Rural nursing practice and education remain a difficult task to achieve in first world countries, let alone in a third world country like Lebanon. The latter sustained 15 years of civil war, followed by ongoing political and economic instability. North and South Lebanon, and Bekaa are rural sites, and are considered the most socioeconomically-disadvantaged geographic locations in the country. This includes severe shortage in Nursing practice and education. Purpose: The aim of this study is to share the experience in the provisional establishment of a School of Nursing in rural Lebanon, hoping that such an initiative would help in lessening the severity in the shortage of qualified nurses rurally, and, thus, in improving health care. Method: The model followed is based on four main pillars, namely approaching the locals, establishing the matrix, designing the curriculum, and setting-up research priorities. Each of these pillars consists of various components at different levels. Results: Approaching the locals and establishing the matrix are essentials and prerequisites for the other two main pillars. The former is time-consuming, requires well-trained human resources, and takes a big proportion of the time allocated to the project. Establishing the matrix, designing the curriculum, and setting-up research priorities are equally-important, and each has its own peculiarities and requirements that are summarized in this manuscript. Conclusion and implications: Setting-up a rural School of Nursing in Lebanon is not a privilege. It is rather a necessity, and requires careful planning and allocation of significant human and non-human resources. However, the experience is very much enjoyable, has a unique flavor, and provides the best solution for the severe shortage in qualified nurses from which the local villages suffer.