Session I (A1): Disease Prevention and Management: “Maternal and Child Adolescent Health” 

Presentation 1: Assessment And Promotion Of Knowledge About Prenatal Folic Acid Importance In Rural Areas Of Mount Lebanon: A Village–Based Intervention

Authors: Suzan Salman, Salah Ghandour

Institutional Affiliations: Department of Health Education, Faculty of Public Health, Jinan University, Tripoli, Lebanon

Background and objectives: Worldwide, there are more than 300,000 cases of neural tube defects annually.  The presence of this anomaly in newborns is thought to be highly linked to a deficit in folic acid intake during pregnancy.  The current study is aimed at the assessment of knowledge, attitude and common practices related to the use of prenatal folic acid before and after conducting awareness promotion sessions in two villages in Mount Lebanon using two different behavioral change models.

Methods:  The promotion sessions, about the importance of folic acid usage, were applied to a group of 83 women in Ammatour according to Health Belief Model (HBM) and to a group of 61 women in Ramlieh according to Theory of Planned Behavior (TPB). A pretest, an immediate posttest and a delayed posttest (8 weeks after the sessions) were done to assess the knowledge of each group.

Main Results: The pretest evaluation of the Knowledge Attitude and Practice has shown that only one-third of interviewed females identified folic acid and its roles. The immediate posttest results showed highly significant (p<0.001) improvement in the level of knowledge about folic acid in both groups (98%). The delayed posttest revealed that the HBM group showed significantly (p<0.05) better results than the TPB group in recalling the information.

Conclusion & Recommendations: The present study reveals the lack of knowledge about folic acid among women in rural villages and emphasize the effectiveness of health promotion to increase awareness especially by the Health Belief Model. The Lebanese Ministry of Public Health and non-governmental organizations must increase their efforts to spread and promote the importance of folic acid usage among childbearing women.

Presentation 2: “She Needs Her Husband” – A Qualitative Study Exploring Factors Influencing Male Involvement In Family Planning Uptake Among Syrian Refugees, Shatila, Lebanon

Authors: Wafaa Chreif¹, Wilma van den Boogaard^1,2, Mariam el Ali¹, Wissam Ahmad¹, Krystel Moussally³, Chantal Lakis², Petros Isaakidis⁴, Eva de Plecker²

Institutional Affiliations: ¹Médecins Sans Frontières, Operational Centre Brussels, Lebanon mission, Beirut, Lebanon ²Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium ³Médecins Sans Frontières, Operational Centre Brussels, Lebanon branch office, Beirut, Lebanon ⁴Médecins Sans Frontières, South African Medical Unit, Capetown, South Africa

Background and objectives: It is believed that without women’s empowerment and male involvement Family Planning (FP)-uptakes remain low. Female refugees have difficulties accessing FP services, which hamper FP-uptake even more. In 2016, Médecins sans Frontières (MSF) introduced male awareness-raising sessions on FP within its free reproductive health services for Syrian refugees in Shatila refugee camp, Lebanon. A camp characterized by volatile and extreme harsh living-conditions and where refugee couples lack their social networks. A qualitative study was conducted to explore factors influencing male participation in order to have a positive effect on FP-uptake.

Methods: Eight focus-group-discussions were conducted with men and women.

Main Results: Thematic-content analysis generated four main themes: “Importance of FP”, “Choice of FP-methods”, “Decision-making processes”, and “FP-services”. FP became important due to the consequences of being a refugee. Choice of FP-method was heavily influenced by lack of information/misinformation expressed mostly by men and/or bad experiences with a certain FP-method. Although male-decision making was most common for supportive, protective and superiority reasons, couple-decision making was described as most desirable by men and women. The MSF’s FP-services were not considered to be male-friendly: opening hours/waiting times, incompatible with men’s working hours, and not being allowed to be with their wives during consultation were often mentioned by males and females.

Conclusion & Recommendations: In a context where a refugee couple is very vulnerable, empowerment should be focused on couples rather than on women only for FP-uptake as well as making choices. The FP-services should become more male-inclusive. Lastly, emphasis needs to be put on curbing the lack of information/misinformation.

Presentation 3: Child Deprivation among Lebanese and Three Refugee Subpopulations Living in Lebanon: Palestinian Refugees, Palestinian Refugees from Syria and Syrian Refugees; A National Multiple Overlapping Deprivation Analysis

Authors: Zeina Jamaluddine¹, Jad Chaaban², Nisreen Salti², Alexandra Irani², Sawsan Abdulrahim³, Khalil El Asmar⁴, Hala Ghattas¹

Institutional Affiliations: ¹Center for Research on Population and Health² Applied Economics and Development Research Group, ³Health Promotion and Community Health ⁴Epidemiology and Population Health, American University of Beirut, Lebanon

Background and objectives: As social, economic and physical environments within which children develop are strong determinants of child wellbeing, a comprehensive approach that recognizes the influence of multidimensional deprivation on child wellbeing is needed. This study constitutes the first attempt to describe overlapping deprivations faced by Lebanese children (LBN) and of three subpopulations of refugees living in Lebanon; Palestinian refugees (PRL), Palestinian refugees from Syria (PRS) and Syrian refugees (SYR).

Methods: Using data from the UNICEF Household Survey 2016 (n= 6,180 LBN 7,761 PRL; 3,053 PRS; 6,568 SYR children) we report on single and overlapping deprivations using indicators related to survival (nutrition, health, water, sanitation and overcrowding), development (education) and protection (labour, exposure to violence and early marriage). Socio-demographic, and geographical correlates of child deprivation were explored using logistic regression. We are currently conducting multivariable analysis to examine differential predictors of deprivations. All analyses were conducted using Stata 15 and ArcGIS.

Main Results: Children 23 months old or less, are most likely to be deprived in nutrition, largely due to sub-optimal breastfeeding practices. Among children between 24 and 59 months old, 8.2% LBN, 28.9% PRL, 46.2% PRS and 68.5% SYR are deprived in at least two dimensions. About half of PRL, PRS and Syrian children (6-17 years old) were deprived in protection and overcrowding. Education deprivation is of primary concern for Syrian children of school age.

Conclusion & Recommendations: This analysis generates geographical and socio-economic profiles of the deprived children and identifies key deprivation areas of the affected sub-groups to inform effective policy design.

Presentation4: Population Attributable Fraction Of Caffeine And Water Pipe On Low Birth Weight In Deprived Communities In South Of Iran

Authors: Shahrzad Nematollahi¹, Mohammad Ali Mansournia¹, Abbas Rahimi-Foroushani¹, Teimour Agha-Molaie², Hossein Shabkhiz³, Koroush Holakouie-Nanieni¹

Institutional Affiliations:¹ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ² Research Deputy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran ³ Bandar Abbas health research and education station, School of Public Health, Tehran University of Medical Sciences, Bandar Abbas, Iran

 Background and objectives: This study aimed to quantify and compare the main and joint effects of dietary caffeine intake and water pipe smoking on the incidence of low birth weight.

Methods: Relative risk and exposure prevalence for dietary caffeine intake ?and water pipe smoking was calculated based on a population-based prospective study ?in suburbs of Bandar Abbas city (2016-2018). Population Attributable fractions (PAFs) were measured on the relative risk scale. Scenarios based on feasible community-based interventions to reduce caffeine intake and water pipe smoking were used to calculate generalized impact fractions.

Main Results: The cumulative incidence of low birth weight was 16.1% (95%CI: 13.74,18.77). Fifty-six percent of subjects reported dietary intake of more than 100 mg/day caffeine and eight percent reported water pipe smoking during pregnancy. An estimated 13% (95%CI: 9.66, 17.16%) of LBW neonates was attributed to dietary caffeine intake and 14% (95%CI:11.71, 16.67%) to water pipe smoking. Interventions to reduce caffeine intake or water pipe smoking to the national estimate suggest an avoidable burden of LBW cases of 10.7% (95% CI: 6.62, 25.34) and 57% ??(95%CI:50.25,68.61), respectively.

Conclusion & Recommendations: Dietary caffeine and water pipe smoking during pregnancy were found to be modifiable risk factors for low birth weight in suburban communities in ?Iran. Community-based programs to prevent water pipe smoking ?and to control the intake of caffeine ?among women of reproductive age are proposed to reduce LBW burden in the South of Iran.?

Presentation 5: Relationships and Mediators between Food Insecurity and Nutritional Status In 2- To 5-Year-Old Children In Rural Areas

Authors: Abolghassem Djazayery¹, Mina Minaie¹, Ramin Heshmat¹, Ahmad-Reza Dorosty¹   and Ali-Asghar Haeri²

Institutional Affiliation: ¹Tehran University of Medical Sciences and ²Iranian Institute for Health Sciences Research, Tehran, Iran

Background and objectives: Food insecurity and children’s nutritional status have complicated relationships through several variables ? nutritional, behavioral and psychological pathways. The objective of this study was to determine the contribution and association of various variables related to food insecurity and nutritional status (based on anthropometric indices) and the mediator variables in 2-5 years old children in rural areas.

Methods: In this cross-sectional study, including 578 children and their mothers selected by cluster random sampling, food insecurity, dietary intake, parenting, maternal depression, feeding practices and anthropometric indices were determined by standard methods; structural equation modeling (SEM) was used to find associations among the dependent and independent variables.

Main Results: Food insecurity at the household and child levels was, 52.5%, and 13.4% respectively, while the prevalence of wasting (low weight for height) was 13.7% and underweight 15.7% among the children. Parenting (authoritative) influenced the children’s weight for height through feeding practices, and food insecurity effected child’s weight for height, through maternal depression and dietary intake. In the final model, food insecurity had affected the children’s weight for height through dietary intake, child feeding practices and maternal depression pathways.

Conclusion & Recommendations: Child-feeding practices (restriction) were the only full mediator between parenting (authoritative) and children’s weight for height. Food insecurity, dietary intake, feeding practices and maternal depression were partial mediators in the relationships. Thus, it is recommended that in health and nutritional care of mothers and children, appropriate action for reducing maternal depression and improving child-feeding practices receive special attention.

Presentation 6: Study of temporal, spatial and demographic characteristics of fatal motorcycles crashes in Isfahan province in 2012-2016

Authors: Roya Karimi¹, Kourosh Holakouie-Naieni², Ahmad ali Hanafi-Bojd³, Jalal Karimi²

Institutional Affiliations:¹School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran ²Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran ³Department of Medical Entomology & Vector Control, Tehran University of Medical Sciences, Tehran, Iran

Background and objectives: The vulnerability, acceptability, availability and unsafe use of motorcycles in Isfahan province are among the factors justifying the need to study these types of road accidents in this setting. The aim of this study was to investigate the recorded factors related to demographic, temporal and spatial of fatal motorcycle accidents in a five-year period.

Methods: This is a cross-sectional study carried out based on records from the Isfahan Forensic Medicine Office during 2012-2016. The study performed using descriptive and analytical analyzes by SPSS version 20. Spatial analysis for geographical distribution accomplished by ArcGIS 10.3.

Main Results: The distribution of fatal motorcycle accidents was more frequent among men, mean age was 36.19±18.87. Around 94% of the cases had high school diploma or less and were mainly worker (33%). Fatal accidents mostly happened during summer (33.5%), in September (17.3%) and at around 4to8 pm (35%). Driving at night doubles the chance of fatal rollover accidents compared to other types of accident (OR=1.96, CI=1.34-2.86), also the chance of fatal rollover accidents among passengers was 2.38 times more than drivers (OR=2.38, CI=1.60-3.54). In the spatial analyses, Lenjan and Mobarakeh were high risk cities in Isfahan province.

Conclusion & Recommendations: Driving over the speed limit at night-time leads to fatal rollover accidents especially among passengers, because wearing helmet is not mandatory among passengers. The high-risk cities in this study have agriculture and steel industries with so many workers who are the main occupational class of the victims as mentioned.

Presentation 7: Epidemiological approach of school Accidents in the center of Tunisia: A Five Years Study

Authors: Amira Omrane, Leila Mrabet, Taoufik Kalfallah, Lamia Bouzgarrou,

Institutional Affiliations: Occupational Medicine and Ergonomics department, Faculty of Medicine of Monastir, University of Monastir, Tunisia

Background and objectives: Assessment of school accidents annual incidence and their victim’s epidemiological profile, in the central Tunisia governorate of Mahdia.

Methods: A five years retrospective study, was conducted on school accidents which occurred on primary, basic, secondary and university school of Mahdia governorate; declared to the Mutual School and University Accidents insurance MASU; and initially taken in charge at the University Hospital of Mahdia. Data were collected both from the insurance and the medical records

Main Results: At total, 3248 school accidents were identified with an annual incidence of 0.69 per 100 pupils and students per year.  Among victims, sex ratio was 1.58 and average age 14.51±0.059 years. The average lost school days, was 12.23±1.73 days. Falls were the leading mechanism in 56.58 % of cases. Bruises and fractures were respectively noted in 32.43 % and 30.51 % of lesions. Accidents occurring during sports or leisure activities were significantly more serious (p= 0.021). School accidents, requiring surgical interventions, were statistically more frequent among male victims (p=0.00), victims of physical education accidents (p=0.000); those associated to falls (p=0.000), to crushes mechanisms (p=0.002) and injuries affecting lower limbs (p=0.000). Multi-varied analysis concluded that school accident severity was correlated to the activity practiced during the trauma and the geographical location of the school.

Conclusion & Recommendations: Our results objectified an elevated incidence of school accident among children and adolescents, with a considerable rate of severe injuries. That implies the necessity of preventive strategy, based on safety and security rules and adapted to the specificity of the context.