System In Lebanon Research Articles

The impact of economic crisis, COVID-19, and the Beirut Blast on colorectal cancer patients in Lebanon: A trend to operate more late-stage complex cases.

The convergence of the economic crisis, COVID-19 pandemic, and Beirut Blast has precipitated unprecedented challenges for the healthcare system in Lebanon, particularly for cancer patients. Amidst these crises, our study evaluates its contribution to a concerning trend of operating on more late-stage and complex colorectal cancer (CRC) cases. We included 155 patients operated for CRC between 2017 and 2023. Patients age; sex; operation type (emergency or elective); tumor size, grade, and location; tumour, node, metastasis stage; lymphatic, vascular and perineural invasions; American Society of Anesthesiologists (ASA) score, presentation and previous history, and complications were examined. Surgical outcomes remained relatively consistent before and after the crisis. However, there was a notable increase, with patients being 3.59 times more likely to undergo resection of adjacent organs in metastatic disease post-crisis. Patient characteristics also exhibited notable shifts, with a 9.60-fold increase in the likelihood of having an ASA score of at least 2 after the crisis. Additionally, there was a 5.36-fold decrease in the odds of patients undergoing a colonoscopy before their diagnostic one post-crisis. Preoperative carcinoembryonic antigen levels were significantly elevated post-crisis compared to pre-crisis levels. Pathological findings revealed increased odds of perineural, vascular, and lymphatic invasion post-crisis. Additionally, there was a notable increase in the likelihood of hepatic synchronous metastases post-crisis. Furthermore, a trend to operate on complicated diseases was noted with an increased number of colostomies. The economic crisis in Lebanon has profoundly affected early intervention and comprehensive treatment for CRC patients, resulting in a concerning rise in late-stage cases requiring surgical intervention.

Revolutionizing Healthcare: Lessons Learned from an Integrative Approach to Transforming the Hospital Accreditation System in Lebanon

Background: Lebanon was the first country in the Eastern Mediterranean region to develop and implement a national hospital accreditation system, but the system has not been updated since 2011. This study aims to describe the process of developing and piloting context-specific hospital accreditation standards in Lebanon, and share lessons from extensive stakeholder consultations. Methods: Mixed-methods approach was used for development and piloting of standards. This included extensive documentation review, stakeholder and expert consultations, standard review, and capacity building for piloting. Experts were required to review standards using pre-identified criteria and expert sub-group meetings were conducted to discuss changes. Piloting of standards included assessment of feasibility and compliance with standards/guiding measures in addition to implementation considerations. Results: More than 60 experts were consulted. Pilot testing showed a positive outcome for clarity, feasibility, and compliance of hospitals to standards. Managing stakeholders’ expectation was challenging at the policy-political encounter. The rigorous expert review led to the development of context-specific and robust standards that provided guidance for hospitals to improve quality care. Results showed that health system changes at the governance, finance and delivery levels are needed to achieve and sustain the gains of accreditation. Conclusions: The study methodology showed the promising influence of using science in development of accreditation standards. Stakeholder involvement remains critical to push the agenda of accreditation. Continuous follow-up to the survey process is recommended to ensure optimal impact of the accreditation system. The process can be scaled up and replicated in the Eastern Mediterranean Region (EMR) and beyond. Patient or Public Contribution: Patients and public where not involved in this study. While patients and the public bring are key for sharing lived experiences, the development of the standards required deep understanding and expertise especially with regards to healthcare and health systems. Highlights Implications for policy makers • Study can be replicated in contexts without a national accreditation system • Ensuring political commitment is critical for implementation of accreditation • Rigorous approaches are key in managing resistance to change • Stakeholder engagement is pivotal for developing contextualized standards

Surviving crisis after crisis: strengths and gaps in support for Syrian refugee families living in Lebanon

PurposeAs host to over one million Syrian refugees, Lebanon continues to experience challenges addressing the needs of refugee families. This research examined the experiences of Syrian families with the refugee support system in Lebanon. The purpose of this study was to better understand the strengths and gaps in existing mechanisms of support for these Syrian families, including informal support from family, neighbors and community and more formalized support provided through entities such as nongovernmental organizations and United Nations agencies.Design/methodology/approachData were collected from 46 families displaced by the war and living in Lebanon (N = 351 individuals within 46 families). Collaborative family interviews were conducted with parents, children and often extended family.FindingsThe data identified both strengths and gaps in the refugee support system in Lebanon. Gaps in the refugee support system included inadequate housing, a lack of financial and economic support, challenges with a lack of psychosocial support for pregnant women and support for disabled youth. Despite these challenges, families and community workers reported informal community support as a strong mediator of the challenges in Lebanon. Furthermore, the data find that organizations working with Syrian families are utilizing informal community support through capacity building, to create more effective and sustainable support services.Originality/valueThis study provides an overview of strengths and gaps in supports identified by refugees themselves. The research will inform the development and improvement of better support systems in Lebanon and in other refugee–hosting contexts.

Lebanese diaspora and the October 17 Uprising

AbstractThis article examines the Lebanese home‐diaspora relationship and its contribution to the dynamics of the political system in Lebanon. This relationship is explored in the context of the October 17 Uprising which was a transnational event whereby Lebanese at home and abroad were actively engaged in its awakening and repercussions. The authors argue that this relationship is a two‐way relationship in which both home and diasporic actors mutually contribute to the potential transformative process which was ignited by the Uprising. They also argue that both political actors are faced with limitations that hinder them from maximizing their efforts to challenge and transform the political rhetoric in Lebanon. These limitations are imposed by both local and diasporic actors in favour of traditional political parties, and they restrict the potential of diasporic actors to be proactive in their opposition, as well as the efforts of home actors to enhance the nature of the political engagement with the diaspora. However, the research suggests that recent political activities in Lebanon and abroad have demonstrated the ability of both actors to gradually break the sovereignty of the ruling parties in Lebanon if efforts are channelled properly in the political field generated by those actors.

The emergence of carbapenemase-producing Enterobacterales in hospitals: a major challenge for a debilitated healthcare system in Lebanon.

Carbapenem- and extended-spectrum cephalosporin-resistant Enterobacterales (CR-E and ESCR-E, respectively) are increasingly isolated worldwide. Information about these bacteria is sporadic in Lebanon and generally relies on conventional diagnostic methods, which is detrimental for a country that is struggling with an unprecedented economic crisis and a collapsing public health system. Here, CR-E isolates from different Lebanese hospitals were characterized. Non-duplicate clinical ESCR-E or CR-E isolates (N = 188) were collected from three hospitals from June 2019 to December 2020. Isolates were identified by MALDI-TOF, and their antibiotic susceptibility by Kirby-Bauer disk diffusion assay. CR-E isolates (n = 33/188) were further analyzed using Illumina-based WGS to identify resistome, MLST, and plasmid types. Additionally, the genetic relatedness of the CR-E isolates was evaluated using an Infrared Biotyper system and compared to WGS. Using the Kirby-Bauer disk diffusion assay, only 90 isolates out of the 188 isolates that were collected based on their initial routine susceptibility profile by the three participating hospitals could be confirmed as ESCR-E or CR-E isolates and were included in this study. This collection comprised E. coli (n = 70; 77.8%), K. pneumoniae (n = 13; 14.4%), Enterobacter spp. (n = 6; 6.7%), and Proteus mirabilis (n = 1; 1.1%). While 57 were only ESBL producers the remaining 33 isolates (i.e., 26 E. coli, five K. pneumoniae, one E. cloacae, and one Enterobacter hormaechei) were resistant to at least one carbapenem, of which 20 were also ESBL-producers. Among the 33 CR-E, five different carbapenemase determinants were identified: blaNDM-5 (14/33), blaOXA-244 (10/33), blaOXA-48 (5/33), blaNDM-1 (3/33), and blaOXA-181 (1/33) genes. Notably, 20 CR-E isolates were also ESBL-producers. The analysis of the genetic relatedness revealed a substantial genetic diversity among CR-E isolates, suggesting evolution and transmission from various sources. This study highlighted the emergence and broad dissemination of blaNDM-5 and blaOXA-244 genes in Lebanese clinical settings. The weak AMR awareness in the Lebanese community and the ongoing economic and healthcare challenges have spurred self-medication practices. Our findings highlight an urgent need for transformative approaches to combat antimicrobial resistance in both community and hospital settings.

Healthcare workers’ experiences of workplace violence: a qualitative study in Lebanon

BackgroundThe COVID-19 pandemic has brought unprecedented challenges to healthcare workers (HCWs) around the world. The healthcare system in Lebanon was already under pressure due to economic instability and political unrest before the pandemic. This study aims to explore the impact of COVID-19 and the economic crisis on HCWs’ experiences of workplace violence in Lebanon.MethodsA qualitative research design with an inductive approach was employed to gather data on workplace violence through Focus Group Discussions (FGDs) from HCWs in Tripoli Governmental Hospital (TGH), a governmental hospital in North Lebanon. Participants were recruited through purposive sampling. The interviews were conducted in Arabic, recorded, transcribed, and translated into English. Thematic analysis was used to analyze the data.ResultsA total of 27 employees at the hospital participated in the six FGDs, of which 15 females and 12 males. The analysis identified four main themes: (1) Types of violence, (2) Events witnessed, (3) Staff reactions to violence, and (4) Causes of violence. According to the interviews conducted, all the staff members, whether they had experienced or witnessed violent behavior, reported that such incidents occurred frequently, ranging from verbal abuse to physical assault, and sometimes even involving the use of weapons. The study findings suggest that several factors contribute to the prevalence of violence in TGH, including patients’ financial status, cultural beliefs, and lack of medical knowledge. The hospital’s location in an area with a culture of nepotism and favoritism further exacerbates the issue. The staff’s collective response to dealing with violence is either to submit to the aggressor’s demands or to remove themselves from the situation by running away. Participants reported an increase in workplace violence during the COVID-19 pandemic and the exacerbated economic crisis in Lebanon and the pandemic.ConclusionInterventions at different levels, such as logistical, policy, and education interventions, can help prevent and address workplace violence. Community-level interventions, such as raising awareness and engaging with non-state armed groups, are also essential to promoting a culture of respect and zero tolerance for violence.

Factors Affecting Purchase Intention Toward Solar System in Lebanon

Factors Affecting Purchase Intention Toward Solar System in Lebanon

Communicable Disease Surveillance in Lebanon during the Syrian Humanitarian Crisis, 2013-2019.

Lebanon has been one of the most affected countries by the Syrian humanitarian crisis. The national communicable disease surveillance was enhanced to detect outbreaks among Syrians. In this study, we aim to describe the findings of the communicable disease surveillance among Syrians in Lebanon, compare it to residents' data, and describe the implemented surveillance activities between 2013 and 2019. During the study period, data on communicable diseases was mainly collected through the routine national surveillance system and an enhanced syndromic surveillance system. Predefined case definitions and standard operating procedures were in place. Data collection included both case-based and disease-specific reporting forms. Descriptive data and incidence rates were generated. Information was disseminated through weekly reports. Activities were conducted in close collaboration with different partners. The most commonly reported diseases were: viral hepatitis A, cutaneous leishmaniasis, mumps, and measles. Hepatitis A incidence increased in 2013 and 2014 among Syrians as well as residents. For leishmaniasis, the incidence increased only among Syrians in 2013 and decreased after that. An outbreak of mumps was reported among Syrians between 2014 and 2016, with a peak in 2015 concomitant with a national outbreak. Outbreaks of measles were reported among Syrians and residents in 2013, 2018, and 2019. The infrastructure of the well-implemented surveillance system in Lebanon has been utilized to monitor the health status of Syrians in Lebanon, early detect communicable diseases among this population, and guide needed preventive and control measures. This highlights the importance of having a flexible surveillance system that can be adapted to emergencies and the importance of sharing results with involved partners.

Lebanon’s Political Opposition in Search of Identity: He Who Is Without Sect among You Cast the First Stone

This paper grapples with the impact of the postwar consociational system in Lebanon on the articulation and organization of political opposition, focusing on the period between 2011 and Lebanon’s October 2019 protests. It argues that the articulation and organization of political opposition is limited by a deeply rooted sectarian episteme of politics as a result of decades of consociational politics and subsequently sectarian state–society relations. The paper shows how nonsectarian oppositional actors concede to the pervasiveness of sectarian identity by resorting to a very narrow or very broad articulation of demands, avoiding, in the process, confrontation with sectarian prejudice. The paper also shows how, conscious of the pervasiveness of sectarian identities, sectarian actors have continued to hold popular support and discredit narrow and broad demands by resorting to sectarian identities. Whilst there are many factors that help explain the weaknesses inflicting political opposition, this paper focuses on the question of identity, not as a mere analytical tool constructed by elites, but as a seemingly authentic articulation, which is initially generated through routine practices that, indeed, elites and the state play a defining part in structuring.

Disastrous decline of the healthcare system in Lebanon.

Disastrous decline of the healthcare system in Lebanon.

The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in Lebanon.

To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital. A pre-post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre-period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post-period. The total number of deliveries during the study period was 2560; 1305 patients were included in the pre-period and 1255 patients delivered in the post-period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P= 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P= 0.02 and 0.01, respectively). The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice.

Land use impacts of implementing a bus rapid transit system: case of Beirut southern corridor

This study investigates and forecasts the effects of implementing a newly proposed Bus Rapid Transit (BRT) system in Lebanon on the urban land use evolution between the years 2019 and 2049. It contributes to the emerging scientific literature by proposing a technique intended to identify the potential urban land use impacts of BRT. The identification of these impacts as part of the feasibility study for the BRT is considered important for policymakers, local officials, and urban planners. The impacts are identified by conducting the Analytical Hierarchy Process, based on data collected via survey and interviews with real estate experts. The outcomes show that implementing a BRT service complemented with bus feeder services will: (i) reshape the urban fabric, in proximity to BRT routes and particularly around the stations, by triggering the Transit-Oriented Development and increasing the attractivity of urban development by 6 to 9% according to the distance from BRT route; and (ii) increase the attractivity of urban development projects by 11% in areas distant from the highway if these areas are characterized by high coverage of bus feeder services, low possibility of an increase in estate prices, and medium to high public acceptance of the proposed BRT.

Truman in Beirut: Journeying Through Fear and Immobility

ABSTRACT After an incident at home leads to a ruptured tendon and forces me into immobility for four months – a period extended by the negligence and indifference of a starved medical system in Lebanon – I grow aware of the mirrored mental stagnation and disorientation that plagues the population as a result of desensitisation. In this autobiographical exploration, I delve into the distinction between physical and psychological stagnation. Foregrounding Lebanon’s infrastructure of dysfunction and absurdity, which lives on through a corrupt ruling class and a traumatised war generation, I bridge the already infinitesimal gap between family and state, drawing a lived picture of a fatherless collective that thrives on serial trauma, denial, and nostalgia. Finally, as I revisit a few of Lebanon’s past artistic expressions featuring the search for national identity, I suggest that this identity, which has perhaps always revolved around its lack thereof, both within and without the border, drives us yet again to search for meaning, no matter where we stand.

Implementation of a Pharmacovigilance System in a Resources-Limited Country in the Context of COVID-19: Lebanon's Success Story.

Implementation of Pharmacovigilance (PV) systems in resource-limited countries is a real challenge. The objective of this paper is to describe the implementation of an effective national PV system in Lebanon in the context of COVID-19, within a limited resources setting and with the absence of a guaranteed funding. In 2018, the PV center hosted at the Lebanese University, Faculty of Pharmacy under the supervision of the Quality Assurance of Pharmaceutical Products Program within the Lebanese Ministry of Public Health became an associate member of the World Health Organization (WHO) Program of International Drug Monitoring and recognized as Full member in 2021.This analysis highlights the requirements of the WHO that were met in Lebanon to create an effective PV system. The Lebanese experience shows that it is not only possible, but also crucial to implement a PV system in low to middle-income countries with limited resources and with the absence of a guaranteed funding in order to be able to promote patients’ safety. Support from organizations like WHO and World Bank, skilled leadership, hard work and dedicated staff with efficient training, and finally mass awareness initiatives were all considered as key elements to implement a successful PV System. In the midst of a turbulent political, economic and health context, Lebanon has been able to develop one of the most active and rapidly evolving PV systems in the Middle East.

Lebanese Sunni Muslim Politicians’ Narratives on the Political and Religious Leadership of the Lebanese Sunnis: Reconstructing Inclusive Political Leadership in Lebanon

In this article, Sunni Muslims politicians’ narratives on the political and religious leadership of the Lebanese Sunnis are examined in an effort to reconstruct inclusive political leadership in Lebanon. The Lebanese Sunnis are primary actors in the Lebanese politics. The significant role played by Sunnis is recognised in the National Pact 1943, which paved the way for Lebanon’s independence from France together with the Taif Agreement, which ended Lebanon’s civil war. The signing of the agreements culminated into the establishment of the confessional political system in Lebanon and enabled the Sunnis to constitute an integral part of that system. However, Lebanon is still saddled with internal political problems worsened by the struggle for influence over Lebanon from external actors. The overlapping between domestic and foreign factors is critical in constructing Sunni narratives on their leadership. Sunni framing constructions suggest that the Sunni leadership is galvanising the Sunni community to serve its own interests. The disempowerment of Sunnis is mainly attributed to the failure of their political and religious leadership. This article, therefore, argues for the reconstruction of inclusive leadership in Lebanon. This will enable the Lebanese actors to delegitimise identity politics and promote national cohesion and stability. It also recommends the establishment of independent electoral commissions, prohibition of foreign funding of political groupings, and dismantling of the confessional political system in Lebanon.

Pipeline Modelling for the Lebanese Offshore: Cases in the Oil and Gas Industry

Lebanon must build a pipeline system to carry the hydrocarbons from offshore to the shore. With no available studies and not much experience in this domain, designing a pipeline system in Lebanon is a topic of great concern. In this research, a prototype sample for the Lebanese offshore pipeline system is designed taking into consideration different parameters such as the drainage area, skin factor, Dietz shape, production interval, and the wellhead pressure. The system carries the gas from block 9 offshore Lebanon to a suitable production platform using different simulation software, mainly PROSPER. Different scenarios are modelled where results showed an optimum flow rate of 322.834MMscf/day and a wellbore pressure of 6460.73psi at 3000psi wellhead pressure. Further studies are encouraged to be carried out to transport the hydrocarbons from the wellheads of block 9 to the Zahrani processing plant via specified hydraulics engineering software.

HSD42 Trends in Non-COVID Healthcare Utilization during the Pandemic in Lebanon

The Coronavirus disease pandemic (COVID-19) resulted in major disruption to health systems worldwide and particularly affected the delivery of non COVID-19 related care. In addition to the pandemic, the healthcare system in Lebanon was struggling with a severe financial crisis, which was jeopardizing delivery of care to patients with non-communicable diseases (NCD). The study aims at evaluating the impact of the pandemic on non-COVID healthcare utilization by NCD patients in Lebanon.

Historical Construction of Local Food System Transformations in Lebanon: Implications for the Local Food System

Food system transformations occur in a complex political, economic, social, and territorial landscape. The study provides a historical construction of global food regime changes and the adaptiveness, transformability, and resilience of the local food system in Lebanon, a Middle Eastern context. Lebanon offers a unique opportunity to understand the influence of global food regimes and geopolitics on agriculture, the local food system, and capital accumulation. After the 1975–1990 Lebanese Civil War, Lebanon experienced food retail transformation and international penetration through foreign investments. These alterations have several implications for society and the local food system: farming households' influence on agricultural policies and the political commitment to support the farming community decreased. The paper concludes that Lebanon's local food system transformation is a manifestation of geopolitical events and global food regime changes. This may have important implications and pave the way for a new food system that is based on the revitalization of agriculture and new forms of geoeconomic partnerships with regional actors.

Gifted education in Lebanon: Re-examining the role of educational and learning capitals

This theory-based article explored the role of educational and learning capitals in the education of gifted learners in Lebanon. The article introduced the educational system in Lebanon, the impact of the Syrian crisis, refugee challenges to gifted education in Lebanon, the conception of giftedness, expenditures on schools, and higher education institutions. The paper provided a comprehensive categorization of learning resources including ten educational and learning capitals in relation to gifted education in Lebanon. Evidence-based literature was constructed on each of the educational and learning capitals. Several conclusions and implications were introduced in relation to gifted education expenditures, gifted conceptions and identification, gifted teacher preparation, and gifted learning resources management.

Blood Donation in Lebanon: A Six-Year Retrospective Study of a Decentralized Fragmented Blood Management System.

IntroductionIn developing countries, the lack of a sufficient and safe blood supply is a significant impediment to providing health care. Lebanon is notable for its absence of a Donor Management System to ensure continuous donor recruitment and scheduling. Herein, we report the findings of Lebanon's first large retrospective population-based study to investigate blood types and donation that is critical for managing community blood supply.MethodsThe non-remunerated voluntary blood donors were recruited by the non-profit organization “Donner Sang Compter”. The study spanned six years, from August 2015 to May 2021, and included 36,002 people from 18 districts throughout Lebanon's nine governorates.ResultsThe most prevalent blood type was A (42%), followed by O (37.48%), B (13.86%), and the AB group (6.84%). RhD+ groups were predominant (88.45%), with A+ being the most (37.84%) and AB- being the least prevalent (1.05%). Furthermore, blood type and donation profiling revealed a substantial geographical variation in the frequency of blood groups, despite the relatively small country’s area. As for blood donation, when gender and age were considered, young male donors dominated the pool across the country.ConclusionThis study on blood type prevalence and blood donor demographics may pave the way for the development of a more coherent and integrated blood management system in Lebanon, as opposed to the fragmented and decentralized system now in existence. These findings also provide crucial clinical information for the country's future transfusion medicine policies and practices, which is vital in such a precarious part of the world.